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ONITORING WELL INSTALLATION'REPOi <br /> Date: _l/ CONSTRUCTION <br /> Premise Address: �. ��2%wu'�- Total Depth -7.5 <br /> Screen Length (from) S.S (to) Z� <br /> Well No.: Filter Pack (from) <br /> Bentonite (from) (to) <br /> Inspector: JGrout (from) (to) <br /> 3�/ Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: TT casing <br /> height <br /> Consultant <br /> Geologist ABOVE-GROUND <br /> COMPL.�TJON C�MISTY-80X <br /> COMP <br /> SPECIAL PERT INFO. Ground Surface <br /> MI +w•. <br /> �� <br /> Distance to sewer line grout— ft.Domestic well on site - ( y ) <br /> If yes, location and distance - c tt- <br /> 72 <br /> O <br /> C <br /> O <br /> SAMPLING slotted = c <br /> sac5on <br /> Holding Temperature 7 6 �' grave'Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet y n ) �✓�' <br /> tt. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n <br /> Storage Location C3'1_ Casing type 7 <br /> Blank O ft. Screen A5, ft. <br /> Slot size .01-0 <br /> GROUTING Bags cement 3 <br /> Buckets bentonite ` <br /> Depth to water 7Y> 5 Bags sand/gravel Z <br /> Mix Ratios /0 Filter Pack type/size <br /> Installation Method Surge BIock: - CY n ) <br /> Quantity Installed Discussed with geologist;- n) <br /> Type of method <br />