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#NITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: 42a Total Depth <br /> Wel] No.: / Screen Length (from) SI• (to) ZD <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from)—(to)- <br /> Grout <br /> from) (to)Grout (from) (to) <br /> Permit No. t16�11 Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pi stye (circle one) <br /> Driller:__ AA t G ljh l <br /> kk casing <br /> Consultant_ LiA� <br /> height <br /> Geologist_ tuo b6ti 4k V- <br /> ABOVE-GRCUND T T <br /> COMPLETION CHRZTY-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> ��.Ground Sudan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 4 zro h <br /> 3v z h. <br /> a <br /> SAMPLING c <br /> dotted — c <br /> Holding Temperature <br /> Method = vi„d Pack <br /> Screening Method 11 = <br /> Tracking Sheet n ) 70U <br /> fie// SIS ft. <br /> SPOILS tt' <br /> S1•S <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n <br /> Storage Location / 6} Casing type <br /> Blarilc ll� h. Screen <br /> GROUTING Slot size_ <br /> / Bags cement <br /> Buckets bentonite <br /> Depth to water_ �I 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 /> EH 29 29 Type of method <br />