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`"MONITORING WELL INSTALLATION REPOre <br /> Date: l T�l����//'// Y--7 CONSTRUCTION <br /> Premise Address: a Total Depth <br /> Screen Length (from) `7 O (to) 3y <br /> Well No.: Filter Pack (from) (to) 2$ <br /> Bentonite (from) (to) 25 <br /> Inspector: Grout (from) Z5 (to) /r <br /> Drilling rig type Gju-E 85 <br /> Permit No. Auger O.D. / I.D. 16 <br /> Drilling Company: <br /> AIX& Completion - Stove pipe/christie box (circle one) <br /> Driller:— f casing <br /> � <br /> height <br /> X— <br /> Consultant I �_W <br /> Geologisty •- 7F <br /> ABOVE-GROUND C4-iS*TY43OX <br /> COMPLETIONCOMPLETION <br /> SPECIAL PERMIT INFO. CR=rd SL;riace <br /> Distance to sewer line r `7 ;rout <br /> Domestic well on site - ( y n Z S <br /> ft. <br /> If yes, location and distance - <br /> n. <br /> 73 <br /> I ,I• O <br /> SAMPLING slotted <br /> Holding Temper tureprayel <br /> - G <br /> Method = s <br /> ack <br /> Screening Method = `; <br /> Tracking Sheet y n ) —_ <br /> S� tt. „Y .• n. <br /> SPOILS ,� <br /> Storage Method 410 MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n Ov� <br /> Storage Location Jt`fL Casing type r <br /> Blank 3 U ft. Screen 20ft. <br /> Slot size .OZO q <br /> GROUTING Bags cement h1fit. 11 <br /> Buckets bentonite ;L <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (yCD <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />