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MONITORING WELL INSTALLATION REPO`R' <br /> CONSTRUCTION <br /> Premise Address: / Total Depth <br /> r Screen Length (from) Sc (to) 17 <br /> Well No.: ° 3 Filter Pack (from) Opo (to) /!o <br /> Bentonite (from) /b (to)� <br /> Inspector: Grout (from) (to) O <br /> G Drilling rig type �7- 30 DT Glp <br /> Permit No. /�6 s� Auger O.D. $ I.D. .1 <br /> l� n Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 1. <br /> Driller: '4C t "2— casing <br /> 4NT— <br /> Geologist <br /> height <br /> Consultant T <br /> A8CNE-GROUND C GiSTY-BOX <br /> COA�LETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N grout <br /> Domestic well on site - ( y <br /> If yes, location and distance - ft. <br /> 0 n. <br /> = c <br /> S' c <br /> SAMPLING slotted = 8 <br /> sacion = r <br /> Holding Temperature = grxviW pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> 910 <br /> SPOILS <br /> Storage Method Q°— e MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) if T <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size / <br /> GROUTING Bags cement / �— <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 2-Z" Of + Filter Pack type/size Z 2 2— <br /> Installation <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geo1 ogist: - ( y �'n� <br /> Type of method <br /> EH 29 29 <br /> S o . 2 <br /> r <br />