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MONITORING WELL INSTALLATION REPO <br /> Date: �/ as/ CONSTRUCTION <br /> Premise Address:�IV E <br /> Total Depth <br /> Well No.: M'k/- Screen Length (from) (to) <br /> Filter Pack (from) (to) b <br /> ` `� Bentonite (from) L (to) Z <br /> Inspector _ Grout (froin) (to) --4- <br /> Drilling rig type <br /> Permit No. Auger O.D. I 1 I.D. <br /> n. � J Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: /u ti <br /> Driller: '(QJy/rw� SOW casing <br /> Consultant[ J height a <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHFISTY4= 3' <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> tt. <br /> Y <br /> O <br /> SAMPLING = o` <br /> slotted — 'c 1 d <br /> sec9on <br /> Holding Temperature = <br /> Method — gravel Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> b$• I <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type 2 r d>d& <br /> Blank y8 ft. Screen ° ft. <br /> Slot sizey.or D <br /> GROUTING Bags cement <br /> Depth to water S Buckets bentonite So <br /> P Bags sand/gravel t +i <br /> Mix Ratios_A a df (/r Filter Pack type/size <br /> Installation Method -M�. Surge Block: - ( y/ n <br /> Quantity Installed Discussed with geologist: - (0/ n ) <br /> EH 29 29 Type of method <br />