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w1ONITORING WELL INSTALLATION REPS. <br />( <br /> Date: 7— t t to CONSTRU ON <br /> Premise Address: - Total Depth <br /> Screen Length (from) (to)_ f�5 <br /> Well Na.; Filter Pack (from) (to) 4. 14 <br /> Bentonite (from) t2-.+Inspector: Grout (from) °9 (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. _ <br /> Completion - Stove pipelchristie box (circle one) <br /> Drilling Company: <br /> Driller4- caging <br /> height <br /> Consultant _ I'L .' <br /> Geologist <br /> ABOVE-GROUND <br /> OOWPLETZN R <br /> SPECIAL PERMIT INFO. Ground Surfact <br /> Distance to sewer line �0, grout <br /> Domestic well on site - (y <br /> if yes, location and distance - ft. <br /> CDD <br /> SAMPLING slood ` <br /> on w' <br /> Holding Temperature gravW packf <br /> Method ' <br /> Screening Method t4 o {' '. <br /> Tracking Sheet - y n45 <br /> ) <br /> Y <br /> $g <br /> t. x .M1a <br /> SPOILS <br /> Storage Method '� MATERIALSIDEVELOPMENT <br /> Contamination Noted - (y n 4' <br /> Storage Location Casing type <br /> Blank ft. Screen ft, <br /> Slot size t 1 <br /> GROU"T"ING Bags cement <br /> Buckets bentonite <br /> Depth to water 30, Bags sand/gravel <br /> Mix Ratios tt Filter Pack type size Z <br /> Installation Metha Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogxst: - n <br /> Type of method <br /> EH 29 29 <br />