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90NITORING WELL INSTALLATION REPO <br /> P P'1J <br /> Date: o /�� n CONSTRUCTION <br /> Premise Address: ;S)OO �D�fs uM `�ey Total Depth 1�0 <br /> Screen Length (from) I`EO (to) <br /> Well No.: L 'LC Filter Pack (from)_ I00 (to) I <br /> r/ g Bentonite (from) z L (to) <br /> Inspector: Grout (from)-1 (to)_ ul� <br /> Drilling rig type <br /> Permit No. 0I I 7 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 1n-Ut1,. riP�Rani� <br /> Driller: casing <br /> Consultant <br /> < lcltl-�e height <br /> �N�O l <br /> —EFW-F <br /> --- <br /> ABOVE-GROUND Geologist CONFLETION CHAISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Grourd SuAxw <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) f� <br /> If yes, location and distance - n. q ft. <br /> ft. <br /> 1� <br /> SAMPLING 810ned <br /> wc4on =_ <br /> Holding Temperature gmvil pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet • ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 'I`P <br /> INC, CLQ `fG <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot sizeO,PID <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ! t Bags sand/gravel / <br /> Mix Ratios Filter Pack type/size 1 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />