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�NITORING WELL INSTALLATION REPf'R6 <br /> Date: �Q/7/U� CONSTRUC71ON <br /> Premise Address: Total Depth <br /> `a A� l Screen Length (from) 3 i (to) S) <br /> Well No.: /�`�/ Filter Pack (from) -13 5 (to) <br /> ' n Bentonite (from)) 1.o (to) D <br /> Inspector: Grout (froqq�� rG 1. o (to) ..�. <br /> Drilling rig 711(�I <br /> � <br /> Permit No. Auger O.D. ly I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant eV- q V, <br /> Geologist ^kt <br /> ABOVE-GROUND CNAISTY-BOX <br /> COMPLETbN COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Sufan <br /> Distance to sewer line gro(A <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - )4 ft. <br /> S3 3 ft. ft. <br /> _ - m <br /> — e <br /> = e <br /> SAMPLING - <br /> sbitsd c <br /> �//��, saction — <br /> Holding Temperature,4 T = 7ave,Pack <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) <br /> 73-3m = F ft. <br /> SPOILS I n 4 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) "PUL S� �o <br /> Storage Location Casing type <br /> Blank--CZft. Screen <br /> Slot size 0 -0/o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 49-- Bags sand/gravel <br /> Mix Ratios "M e Filter Pack type/ ize Y iL <br /> Installation Method Surge Block: - y/ n ) <br /> Quantity Installed Discussed with geologist: - V/ n ) <br /> Type of method <br /> EH 29 29 <br />