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MONITORING WELL INSTALLATION REPO'rr <br /> Date: �� t �' t �� CONSTRUCTION <br /> -1 <br /> Premise Address: � � � C /k�A­C.� ��._ Total Depth <br /> Screen Length (from) (to) ` <br /> Well No.: 1 � `� Filter Pack (from) o (to) -3 — <br /> Bentonite (from) (to)--� <br /> Inspector: s �� <br /> \ Grout (from) :- 1 (to)± u� t Ut,_ <br /> Drilling rig type t L `� _ <br /> Permit No._ f� ' C.P` ( � Auger O.D. - "\C _ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:�1� Cr'�ru 4 <br /> Driller: u �� casing <br /> .f height <br /> Consultant„ 11 (1 � 'd 'V <br /> Geologist <br /> ABOVE-GRCIJNO <br /> OOMPL JON cOn,+Pi..mcN CMPL MN <br /> SPECIAL PERMIT INFO. Ground Surface ---� <br /> Distance to sewer line Craft <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING tlorni — <br /> secicn <br /> Holding Temperature v� <br /> Method — <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) _ a' Casing <br /> Storage Location g type <br /> Blank �� ft- Screen ft. <br /> Slot size Al <br /> GROLMNG Bags cement Q "� <br /> _ Buckets bentonite U <br /> Depth to water Bags sand/gravel <br /> Mix Ratios6 ,-,C. . C+PnVy--- _ I Filter Pack type/size'' <br /> Installadon MethodOk Surge Block: - ( y/ n ) <br /> Quantity Installed ! TMEV Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />