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QONITORING WELL INSTALLATION REPO <br /> Date: '512-14� <br /> CONSTRUCTION <br /> Premise Address: 7: 741(1- Ae s Total Depth <br /> Screen Length (from) f/O (to) d <br /> Well No.: ��o Filter Pack (from) /// (to): — <br /> n/J Bentonite (from) F 6 (to) y£r <br /> Inspector: Grout (from) -71�6— (to) a <br /> �� Drilling rig type /1yiJ c� �� <br /> Permit No. l/ (o Auger O.D. I.D. <br /> Completion - Stove pi christie box ircle one) <br /> Drilling Company: �u f�d/� vu t-z- <br /> Driller: casing <br /> height <br /> Consultant �/5 i`f T <br /> Geologist fdl �//�/I i�f ABOVEGROUND T <br /> COMPLETION CHRIST`!-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. GrourdSurface <br /> � <br /> Distance to sewer line SOGC��+ / �P/N// grout <br /> Domestic well on site - (y/ n) r L_n. <br /> If yes, location and distance - n, <br /> n. <br /> a <br /> SAMPLING $losocdon <br /> nad <br /> Holding Temperature ' = 9tivelP&* <br /> Method <br /> Screening Method ' <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method mOe r/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) ' <br /> Storage Location 5�) SinCZ11 Casing type LTi 5/- !S- <br /> Blank <br /> Blank ft. Screen ft. <br /> Slot size &2 r o 3 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br />