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MONITORING WELL INSTALLATION REPOn f <br /> Date: /2 'l�''U g 6!) CONSTRUCTION <br /> Premise Address: 4� � - Total Depth <br /> Screen Length (from) (to) <br /> Well No.: S" Filter Pack <br /> (from) (to) <br /> Bentonite (from)_ 39- (to) 3(� <br /> Inspector: Grout (from) (to) c <br /> Permit No. y Drilling rig type CIy—t- <br /> �ll/� r y Auger O.D. /D I.D. (o <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �� <br /> Driller: �` �� casing <br /> height <br /> Consultant <br /> Geologist <br /> t <br /> ABOVE-GROUND CtiRiSTY 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y <br /> If yes, location and distance— ft. <br /> ft. <br /> - O <br /> r <br /> SAMPLING = o <br /> siottad ;; c <br /> socdon — <br /> Holding Tempera&e <br /> Method : = vivel Pack <br /> Screening Method <br /> r = <br /> Tracking Sheet - ( y n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location C./14L&1- 40,-T— Casing type "Ov� <br /> Blank S ft. Screen K6ft. <br /> Slot size -oy-o <br /> GROUTING Bags cement 12- <br /> Buckets <br /> ZBuckets bentonite <br /> Depth to water �J� Bags sand/gravel <br /> Mix Ratios " Filter Pack type/size 2412- <br /> Installation <br /> 12Installation Method_ r.K Surge Block: - ( y n <br /> Quantity Installed /L Discussed with geologis : - X11 ) <br /> EH 29 29 Type of method <br />