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MONITORING WELL INSTALLATIO �T <br /> & I W <br /> Date: ` r ' "yy5� / CONSTRUCTION <br /> Premise Address: ZG�G� ��/� �Ls��� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: 4 ZZ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. S;�Z L �E4 7J Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height —Q <br /> Consultant –�,�j <br /> Geologist- �� X7 '� rPi' T <br /> /6� Aja' COMPLEiIOND CHRZTY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Ori <br /> Domestic well on site - ( y/n ) <br /> If yes, location and distance - ft. <br /> _ft ft. <br /> e <br /> e <br /> r <br /> c <br /> SAMPLING slotted <br /> n <br /> Holding Temperature < __ <br /> Method �` _ vivo,Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> M <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 />