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MI)NITORING WELL INSTALLATION REPST <br /> Date: lAld 4 CONSTRUCTION <br /> Premise Address: �e-l'X4 v Total Depth <br /> G Screen Length (from) (to) <br /> Well No.: r T 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 /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COtr�LETION CNAIS'TY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line QfOul <br /> Domestic well on site - (y/n) f <br /> If yes, location and distance - <br /> SAMPLING <br /> slotted <br /> / _ <br /> G ,tet✓ w � C 37 <br /> Holding Temperature ' J r 3�����•'� h �ti' �rf "` ;': <br /> Method 'w' _ grave,Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) " <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n} <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <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 /> EH 29 29 <br /> jZ <br /> i <br />