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INITORING WELL INSTALI.ATiON REPC <br /> Date:����/D� CONSTRUCTION <br /> Premise Address: ��`� V� - Total Depth <br /> 56Screen Length (from) (to) <br /> Well No.: ���'� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> • IF17� height <br /> Consultant 6" `� <br /> Geologist (tt" <br /> • ABOVE-G R CUN D Ck RSTY 30X <br /> QO hr�'L.�'Tf0 N C�}.{pL-"71CN <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line flroc <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - <br /> • ft. <br /> ft. <br /> SAMPLING -" <br /> 1�� :ocicn <br /> Holding Temperature Y �/ — <br /> Method ` per_ f — <br /> Screening Method <br /> :r — <br /> Tracking Shcet y n ) =' — <br /> ft = I rfi. <br /> SPOILS <br /> Storage Method _MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank , fc. Screen ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water'I! Bags sand/gravel <br /> Miz Rados Filter Pack type/size <br /> installation Method Surge Block: - (y/ ii ) <br /> Quantity Installed Discussed vrith geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29. . <br />