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MONITORING WELL INSTALLATION REP.r <br /> t <br /> AA Uv �,4- S <br /> Date: [ <, - CONSTRUCTION rpt oL) Z' Go `40 <br /> Premise Address: 120 <br /> l .;' ..�. Total Depth <br /> Screen 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 /> l-;t height <br /> Consultant_ La -y- <br /> Geologist �r"'j •- T <br /> ABOVE-GROUND <br /> CbMP�ION CF-IRiSTY$QX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfact <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) R. <br /> If yes, location and distance - <br /> - m <br /> 0 <br /> 0 <br /> r <br /> SAMPLING slotted <br /> motion _ <br /> Holding Temperaturegm%,W park <br /> _ <br /> Method <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> tt. tt. <br /> SPOILS (, <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n ) <br /> Storage Location_c'lrr, Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> 1 Buckets bentonite <br /> Depth to waterBags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />