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'MONITORING WELL INSTALLATION REPCh-d <br /> Date: CONSTRUCTION <br /> Premise Address: 7-166 Z I V. Ujd'&dk Total Depth ZS <br /> Screen Length (from) Z 5 (to) (b <br /> Well No.: Filter Pack (from) 'ZS (to) 8 <br /> Bentonite (from) CK (to) S <br /> Inspector: Grout (from) '? (to) O <br /> Drilling rig type &3 <br /> Permit No. 40 4Auger O.D. 1 I.D. (o <br /> wwj �e�_ <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: /�4 casing <br /> height <br /> Consultant <br /> 1pri <br /> Geologist �J� G{�tc4 <br /> ABOVE-GROUND CHRISTY480X <br /> COMPLETION COMPLETIO <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ' ^ grout <br /> Domestic well on site - (yn <br /> If yes, location and distance - ft' <br /> V ft. ft. <br /> O <br /> C <br /> SAMPLING slotted <br /> tecdon <br /> Holding Temperature <br /> ack <br /> Method = ��P <br /> Screening Method <br /> Tracking Sheet - (y/ n ) — <br /> _.�._ft. <br /> SPOILS <br /> Storage Method Pte' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ �► ( / <br /> Storage Location Casing type <br /> Blank ft. Screen l5 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> ,/ i Buckets bentonite IOCf <br /> Depth to water _4Z Bags sand/gravel /tX5,0- <br /> Mix Ratios Filter Pack type/size jwff!�-#1 <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br /> 7 l GZ� <br />