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CHRISTY-BOX <br />COMPLETION <br />Ground Surf act <br />7 <br />casing <br />height <br />grout <br />4 ff . <br />ft. <br />slotted <br />sect on <br />gravvi pack <br />u.5 <br />ABOVE-GROUND <br />COM0 LETION <br />Driller: <br />Consultant 4494-20 <br />Geologist <br />-)NITORING WELL INSTALLATION REPC <br />Date: e-/-?/ <br />Premise Address: ;)0 <br />Well No.: 41iU3 , 4f4. Aar', <br />Inspector: <br />Permit No. <br />Drilling Compan ah(1044va,A7 <br />SPECIAL PERMIT INFO. <br />Distance to sewer line /•00 <br />Domestic well on site - ( y /C3 <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method e->k.. <br />Screening Method fr—/2 Ir• <br />Tracking Sheer -y n) <br />` — SPOILS <br />Storage Method 4-4° .1:3 ' <br />Contamination Noted - ty / n) <br />Storage Location ZA 41(4-1 <br />GROUTING <br />Depth to water /el! <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />c_eg4144 7i17-57d--7 <br />CONSTRUCTION <br />Total Depth <br />Screen <br />- <br />Screen Length (from) <br />Filter Pack (from) <br />Bentonite (from) <br />Grout (from) <br />Drilling rig type <br />Auger O.D. /27cit I.D. Mi( <br />Completion- Stove pipe/christie box (circle one) <br />MATERIALS/DEVELOPMENT <br />ft. Screen /5 ft. <br />010 <br />Bags cement <br />Buckets bentonite 2- (4..") ffe-z-ierYe <br />Nifi.LBags sand/gravel /2 Al <br />Filter Pack type/size 2-fr 2- Ls . <br />Surge Block:. ( y / n )-- <br />Discussed with geologist: - (0/ n) <br />Type of method ere-c-ile.t. <br />L4 45 (to) 7 5 <br />25.S 6 . <br />(to) <br />(to) 0 <br />Casing type <br />Blank <br />Slot size