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ONITORING WELL INSTALLATION REP04 <br /> Date: d d Q�7 10 i CONSTRUCTION /Q <br /> Premise Address: O/ yr Total Depth �/4 <br /> Screen Length (from) (to) <br /> va 24 <br /> Well No.: 'J/ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to)4y <br /> to) <br /> Drilling rig type <br /> Permit No. Auger O.D. /r�y��•D• <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: ✓[Vat �Zi casing <br /> height <br /> Consultant <br /> 13 <br /> Geologist ABOVE-GROUND <br /> COMPLETION �'r CHRIS7Y-BOX <br /> PLETION <br /> SPECIAL PERMIT INFO. nd 8ur1 <br /> grout <br /> Distance to sewer lined ' <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - / D ft• <br /> = m <br /> — o <br /> = m <br /> = c <br /> SAMPLING dot ad <br /> sac4an <br /> Holding Temperature <br /> Method = _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> OD ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) A <br /> Storage Location Casing type <br /> Blankft. If Screen ft <br /> Slot size 1010 <br /> GROUTING <br /> GROUTING Bags cement <br /> SBuckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios t Z2 Filter Pack type/size <br /> Installation Method 4 Surge Block: - (y/ n ) <br /> Quantity Installed ///1/X&1K n.t Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> /0/o Dg ?� C eC' <br />