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"IONITORING WELL INSTALLATION REPS'^" <br /> Date: 0/ ��0 CONSTRUC N <br /> Rio �. � �Lrg. ^ t9S , ot 9 37- 6 �1N �-, <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: !� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. Y'4 I.D. <br /> 'ft� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �I <br /> Driller: casing <br /> height <br /> Consultantc6L•oti,.—,L _q <br /> Geologist JT .- W <br /> ABOVE-GROUND <br /> COMPLETION Ct{RJST'Y-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfac* <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n <br /> If yes, location and distance - u� ft' <br /> = e <br /> c <br /> SAMPLING slot c <br /> secron <br /> Holding Temperature <br /> Method _ P <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS 6(, <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 /> �i Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (©/ n ) <br /> Type of method <br /> EH 29 29 <br />