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OONITORING WELL INSTALLATION REPO• <br /> Date: 7i 2—05 CONSTRUCTION <br /> Premise Address: 1716 3 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: P !�� Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. <br /> B U 7 3 3 T T Auger O.D. 1•T)• <br /> Completion Stove pip christie box (circle one) <br /> Drilling Company: <br /> casing <br /> � t <br /> Driller: il�� 3r height <br /> Consultant ���1 —ZW-f <br /> GeologistAE&E-GROUND CHR*1y.BOX <br /> COMPLETION cOMPLEfION <br /> Grou <br /> SPECIAL PERMIT INFO. ��� rd <br /> Su <br /> Grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n )7 �gyx f.eq JU-0'0" n' <br /> If yes, location and distance - / n•5 n. T. - <br /> _ <br /> = � m <br /> _ <br /> SAMPLING dottedsectcn —_ $ <br /> Holding Temperature or..;* P� <br /> Method <br /> Screening Method <br /> Z <br /> Tracking Sheet - (y/ n) n. <br /> SPOILS <br /> Storage Method r MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) I/Casing <br /> Storage Location Casing type <br /> Blank /5> 3'S�..e fr. Screen /o fr• <br /> Slot size 4 <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> '�� g sand/gravel ' <br /> Depth to water l O Filter Pak type/size <br /> Mix Ratios <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />