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�16NITORING WELL INSTALLATION REPOnT <br /> Date: CONSTRUCTION <br /> Premise Address: / 71-7 Total Depth 0 <br /> n, Screen Length (from) (to) <br /> Well No.: U/ Filter Pack (from) (to) j <br /> Bentonite (from) <br /> Inspector: Grout (from1—(to) o <br /> D o Sia`r'3Drilling rig type 4—E:2 • .S/? <br /> Permit No. Auger O.D. V I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> height <br /> Consultant ��S�i/ e <br /> Geologist �/ (%C ' e p L E <br /> A80VE-GROUND CHRZTY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. GroUod S� <br /> Distance to sewer line grout <br /> Domestic well on site - (y®n ell n. <br /> If yes, location and distance - q5ft. 3 h. <br /> 0 <br /> SAMPLING Blotted = c <br /> 1n Bacton z <br /> Holding Temperature C' <br /> Method �� _ D <br /> ack <br /> Screening Method A✓A <br /> Tracking Sheet - n ) <br /> 55' <br /> SPOILS <br /> Storage Method =S !/i 2� MATERIALS/DEVELOPMENT <br /> Contamination Noted -437 n ) <br /> Storage Location �1� Casing type <br /> Blank fr. Screen ft. <br /> Slot size 01611 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water = Bags sand/gravel a <br /> Mix Ratios Filter Pack type/size A /2 <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />