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"-MONITORING WELL INSTALLATION REPOnve <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth G� <br /> Screen Length (from) to (to) 60 <br /> Well No.: �� Filter Pack (from) &5 (to) _51____ <br /> Bentonite (from) (to) 5' <br /> Inspector: Grout (from) (to) <br /> // Drilling rig type <br /> Permit No. Auger O.D. I.D. g <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: f �� .i' casing <br /> heighttom <br /> , <br /> Consultant �� <br /> Geologist ��+�►�+� ` •� <br /> 31 7:F <br /> ABOVE-GROUND COMPLETION N <br /> SPECIAL PERMIT INFO. Ground Surfaas <br /> Distance to sewer line L grout <br /> Domestic well on site - (y(D ft. <br /> If yes, location and distance - <br /> [eV ft• ft. <br /> CD <br /> SAMPLING <br /> slotted <br /> a saclan = <br /> Holding Temperature �– <br /> Method _ saw Pack <br /> Screening Method << _ <br /> Tracking Sheet - (y/n ) <br /> �ft. <br /> SPOILS <br /> Storage Method — MATERIALS/DEVELOPMENT <br /> Contamination Noted -G7n <br /> Storage Location Casing type 2-« <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water "'1 Bags sand/gravel <br /> Mix Ratios 7° Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> /45vi- Z <br /> C J <br />