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MONITORING WELL INSTALLATION REPOYr, <br /> Date: SOI (Q CONSTRUCTION <br /> Premise Address: �rh a6 Z V / lf�C .P Total Depth <br /> Screen Length (from) (to) <br /> Well No.: l 3 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 /> e Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: f a casing <br /> IffT height <br /> Consultant <br /> Geologist /� �'C�%�` ` <br /> ABOVE-GRWND CHS:S1Y-80X <br /> 00WLET;0N COMPLE71CN <br /> SPECIAL PERMIT INFO. Ground Surtx° <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - tt, <br /> �n. <br /> = m <br /> SAMPLING slotted = *� <br /> axtion <br /> Holding Temperature = grave pec <br /> Method <br /> Screening Method r` <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) 4 � !L <br /> Storage Location Casing type �U <br /> Blank .S ft.N Screen <br /> Slot size . D z o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel Z <br /> Mix Ratios Filter Pack type/size <br /> Installation Method /✓Ok f Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />