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'- nONITORING WELL INSTALLATION REPtwfi <br /> Date: D Z8 CONSTRUCTION <br /> Premise Address: 1i �� Total Depth 7J <br /> Screen Length (from) 10 (to)_ 6� <br /> Well No.: �s�/� Filter Pack (from) (to) <br /> Bentonite (from) 3 (to) <br /> Inspector: Grout (fro V7 (to) <br /> L Q Drilling rig type Aox87 <br /> Permit No. J�` Auger O.D. I.D. <br /> IleCompletion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Consultant <br /> �l-e IT7T height • <br /> Geologist Vie- •- <br /> ABOVE-GROUND CHRtM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft• <br /> If yes, location and distance - <br /> �ft. is ft. <br /> SAMPLING sloud = Y <br /> section — <br /> Holding Temperature <br /> Method <br /> ��P <br /> Screening Method k <br /> Tracking Sheet - (y/n ) `. <br /> SPOILS '"' <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) V k � <br /> Storage Location Casing type <br /> Blank S ft. Screen S ft. <br /> Slot size ZO' <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios f /•// Filter Pack type/size <br /> Installation Mef5od SWIM Surge Block: - (ynfb <br /> Quantity Installed Discussed with geologist: - (yeer-ff% <br /> Type of method <br /> EH 29 29 <br /> 40/Z�/J `s�� <br />