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ABOVE-GROUND <br />COMPLETION <br />casing <br />height <br />C44RISTY-E3OX <br />COMPLETION <br />Grouhci Surface <br />-IONITORING WELL INSTALLATION REPCh... <br />Date: <br /> <br />Premise Address: u <br />4 c) <br /> 4114 f,a4,-t t <br />Well No.: /1 U) <br />141,1 1-teilieriv <br />Permit No. .5-Oe, 706 /gr <br />Drilling Company: <br />Driller: <br />Consultant <br />Geologist ze,g <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted - ( y / n) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />CONSTRUCTION <br />Total Depth 57 <br />Screen Length (from) 2Z._ (to) 3. 7 <br />Filter Pack (from) Lc- (to) 37 <br />Bentonite (from) /'--- (to) -zo <br />Grout (from) 0- 7--- (to) /8 '. <br />Drilling rig type <br />Auger O.D. i'; 5- '' I.D. <br />Completion - Stove pipe/christie box (circle one) <br />MATERIALS/DEVELOPMENT <br />Casing type tle. <br />Blank 0,r- ft. Screen <br />Slot size <br />Bags cement 8-54,,e <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n) <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />Inspector: <br />ft. <br />ye "071.4‘. <br />EH 29 29