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vIONITORING WELL INSTALLATION REPO— <br /> Date: -3 -7e� CONSTRUCTION <br /> Premise Address: /vv�' � L Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> s� l A/ p Drilling rig type <br /> Permit No. �p (J (P (J Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: �" -?Of-- casing <br /> height <br /> Consultant CTS <br /> Geologist �Oa •- <br /> ABOVE-GROUND <br /> CflMPL�GTION C>•iAiSrY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf act <br /> 7 <br /> Distance to sewer line grout <br /> Domestic well on site - ' y n ) Z/ <br /> ft <br /> If yes, location and distance - <br /> - 24 <br /> — m <br /> _ <br /> SAMPLING darted r <br /> sac5on — � <br /> Holding Temperature <br /> grays�pack <br /> Method = <br /> Screening Method —_ <br /> Tracking Sheet ( y/ n ) —_ 1 <br /> SPOILS <br /> Storage Method _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) / tf � -C <br /> Storage Location Casing type <br /> Blank Z(o ft. Screen Z-<D ft. <br /> Slot size O t U <br /> GROUTING Bags cement 1ZX 47-' <br /> Buckets bentonite a L TXYO C � <br /> Depth to water = 3� _- Bnrs-sand/gravel � <br /> Mix Ratios Filter Pack type/size Z !Z <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 3-hz? ' oo <br />