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MONITORING WELL INSTALLATION REPO• <br /> Date: 17 D� 11 S �� L ' 1 6 CONSTRUCTION <br /> Premise Address:'q/ �' GO Total Depth �T�• 5 <br /> Screen Length (from) 1 (to) v <br /> Well No.: G U`t Filter Pack (from) tz t <br /> ' <br /> Bentonite (from) / e (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. OSJ�SS� Auger O.D. 8"ct • RVe I.D. <br /> B�� / Completion - Steve pipe/christie box (circle one) <br /> Drilling Company: /// / - of <br /> Driller: �� � Cfi// casing <br /> height <br /> Consultant ��//,�A ,, 4 -�• <br /> Geologist d c� iLLtfi� - T <br /> ABOVE-GROUND �/rt CHRIS?Y-BOX <br /> COMPLETION /i/c COMPLETION <br /> SPECIAL PERMIT INFO. nd Sul <br /> / r 00,9 6 proof <br /> b W <br /> Distance to sewer line < `O N Wim "^ I 4W 96 <br /> Domestic well on site - (y �n n• <br /> If yes, location and distance - n <br /> IL ft. <br /> = m <br /> = o <br /> = m <br /> SAMPLING sloped _ E <br /> tecdon <br /> Holding Temperature = Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> / 0 tt• = n• <br /> SPOILS / y <br /> Storage Method kAt—t MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ 2 �� �/C <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size o/6 ft <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Z !.i Filter Pack type/size /Z <br /> Installation Method I a` Surge Block: - (y n <br /> Quantity Instal Q t g r Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 11/0 CC * <br />