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,rIONITORING WELL INSTALLATION REP0r— <br /> Date: l!/.¢� CONSTRUCTION <br /> Premise Address: S� Total Depth 0 ' <br /> // Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) ZCe <br /> Bentonite (from) 2 (to) <br /> Inspector: Grout (from) '7 (to) O <br /> Drilling rig type <br /> Permit No. ®� �� Auger O.D. <U I.D. <br /> zz��. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 16T" �� `r casing <br /> C � =7 height <br /> Consultant <br /> ��/G <br /> Geologist f <br /> ABOVE-GROUND <br /> COMPLETION CCHR"ZT '- <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ? grout <br /> Domestic well on site - ( y n ?.Z, <br /> ft. <br /> If yes, location and distance - Z ft <br /> A <br /> 9 <br /> r <br /> C <br /> SAMPLING <br /> sac�on _ <br /> Holding Temperature 7 <br /> Method = P <br /> ack <br /> Screening Method <br /> Tracking Sheet (yj n ) <br /> ft. — ft. <br /> SPOILS / <br /> Storage Method G gg k--:— MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) „ /]y� <br /> Storage Location Casing type <br /> Blank ffV ft. Screen 0.6 ft. <br /> Slot size —0/6 <br /> GROUTING Bags cement ?YA4/// <br /> Buckets bentonite .q'V4 <br /> Depth to water Bags sand/gravel /0 SO <br /> Mix Ratios Filter Pack type/side ? /2 <br /> Installation Method Surge Block: - (y n }neo.�— <br /> Quantity Installed Discussed with geolo i� st: n �G <br /> Type of method <br /> EH 29 29 <br /> 3 <br />