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�..40NITORING WELL INSTALLATION REP64 <br /> Date: I -1 I 15 CONSTRUCTION <br /> Premise Address: S Total Depth 'S <br /> <' p Screen Length (from) 7.S' (to) <br /> Well No.: J 7 Filter Pack (from) 7�5 ' (to) to 1 <br /> Bentonite (from) Col ` (to) (� -1 — <br /> Inspector: Grout (from) 1/ (to) 3 <br /> Drilling rig type / <br /> Permit No. Auger O.D. /6 /, I.D. <br /> Drilling Comp <br /> Completion - Stove pipe/christie box (circle one) <br /> Company:_( � ' <br /> Driller: ! V f� �� J casing <br /> height <br /> Consultant- <br /> Geologist <br /> onsultantGeologist (^ <br /> ABOVE-GROUND CMRfSTY BOX <br /> COMPLlTX7N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surtan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - h' <br /> ft ft. <br /> — a <br /> — e <br /> _ <br /> — c <br /> SAMPLING slotted <br /> M4 sscdon < __ <br /> Holding Temperature = gravil Pack <br /> Method <br /> Screening Method r <br /> Tracking Sheet - ( y/n) _ <br /> SPOILS � �� � / <br /> Storage Method o1% '!-:L `^"� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) I <br /> Storage Location Casing type <br /> Blank D ' ftt. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 5 S Bags sand/gravel <br /> Mix Ratios Filter Pack type/size g��^ <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />