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-)NITORING WELL INSTALLATION REPO. .. <br /> Date:_ –9 /� CONSTRUCTION <br /> Premise Addr s: C Total Depth <br /> Screen Length (from) (to) <br /> Well No.: - 2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. _ 4 o� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> // Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �l dry✓�.�✓/ <br /> u <br /> Driller: casing <br /> height <br /> Consultant , e <br /> Geologist LVA -- <br /> A80VE-GRCUND <br /> COA�LE7iON CNRSS'TY-BOX <br /> COMPLEEMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Ofout <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> te' <br /> SPLING poi 1 .tora.� <br /> N <br /> aectcn �•• — <br /> Holding Temperature n =_ 9MV1W F <br /> ack <br /> Method <br /> b . <br /> Screening Method„ _ <br /> Tracking Sheet - (y/ n ) <br /> //&�—_tt. ft. <br /> SPOILS <br /> Storage Method � MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n <br /> Storage Location LJG'l 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 /> FH 29 90 <br />