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'-.wMONITORING WELL INSTALLATION REP_-,W <br /> Date: l Z Zo CONSTRUCTION <br /> Premise Address: �06 Total Depth r7 <br /> Screen Length (from) (to) <br /> Well No.: �/ C Filter Pack (from) (to) 3 <br /> Bentonite (from) l (to) 2 <br /> Inspector: 4Grout (from) (to) •'v <br /> O%Jf�/ Drilling rig type <br /> Permit No. J / Auger O.D. I.D. <br /> Completion-Stove pipe/christie box tcircle one) <br /> Drilling Company: <br /> Driller: �� r casing <br /> height <br /> Consultant <br /> Geologist cloLe !� W.- . <br /> ABOVE-GROUN <br /> CHRtM43OX <br /> COMPLETION OMPLEn <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> ft. <br /> Ifyes, location and distance - <br /> 2 o2 <br /> N _ <br /> SAMPLING $106d <br /> section <br /> Holding Temperature ' <br /> Method = grz�wPack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> .X <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) i/_!/ <br /> Storage Location Casing type T <br /> Blankft j Screen ft. <br /> Slot size <br /> GROUTING Bags cement 3 !O <br /> Buckets bentonite ��4r _ <br /> Depth to water Bags sand/gravel fi <br /> Mix Ratios Filter Pack type/size ritz <br /> Installation Method Surge Block: - (yn <br /> Quantity Installed Discussed with geo ogist: - ( Y(E) <br /> Type of method <br /> EH 29 29 <br />