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40NITORING WELL INSTALLATION REP <br /> Date: �7 ff CONSTRUCTION <br /> Premise Address: f� � "` "`-�""- Total Depth <br /> Screen Length (from) (to) <br /> Well No.: M"' 2-1 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 Cnrnpany: � t�•��---�' <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist t •- <br /> JtBOVF--GROUND CHRS T1Y-BCX <br /> COL PLETCN COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Sulac* <br /> Distance to sewer line 2W <br /> Domestic well on site - ( y/ n ) ft <br /> If yes, location and distance - i1. <br /> tt. <br /> m <br /> 4 <br /> C <br /> 0 <br /> SAMPLING alotwd <br /> L,� liC�Ot! <br /> Holding Temperature„ — 2 91 pack <br /> Method ._ <br /> Screening Method r JO t <br /> Tracking Sheet - / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) ,�/' Ljc� <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size 4.ko <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 'Ll/Z- <br /> Installation Method Surge Block: - ( y <br /> Quantity Installed Discussed with geo ogist: - 0/ n ) <br /> Type of method <br /> EH 29 29 <br />