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} <br /> D"'NITORING WELL INSTALLATION REP�T- <br /> Date: ii CONSTRUCTION r <br /> Premise Address �v " �fTotal Depth <br /> Screen Length (from) 5oO (to) <br /> Well No.: Filter Pack (from) (to) <br /> f� Bentonite !'20��frotn) ,_(to) yiS <br /> Inspector• L�' ' Grout 1 .50 (from) (to) <br /> c ,? Drilling rig type <br /> Permit No. r��v U Auger O.D. fS I.D. <br /> MM ff�� darl rr ru Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: I`d�/� FJ�Il1'tel•acQk� <br /> O � �c G( <br /> Driller: casing <br /> J <br /> height <br /> Consultant G <br /> —Q <br /> Geologist \ -- T <br /> ABOVE-GROUND CHR1STYWX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground 5urlac;e <br /> Distance to sewer line <br /> prom <br /> Domestic well on site - ( y/ n) ft. <br /> If yes, location and distance - <br /> - ft. <br /> SAMPLING ° �`-- slotted — <br /> �Sfxaec�on (- <br /> Holding Temperature VIVO' <br /> Pack <br /> Method b = <br /> Screening Method <br /> Tracking Sheet - (y/n) :; = <br /> fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) I <br /> Storage Location Casing type i <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement sitNw 40W_ <br /> Buckets bentonite <br /> Depth to water Bags sand/graveh <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 �S G'f°C <br /> I <br /> A1_1" <br />