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' I <br /> d MONITORING WELL INSTALLATION REPDni <br /> Ecc / „ lz- <br /> Date: l 6, 7 P ? -0 9 CONSTRUCTION <br /> 7 I <br /> Premise Address : Total Depth75 Z <br /> Screen Length (from) S (to) �oS <br /> Well No. : i / �z ' Filter Pack (from) (to) <br /> Bentonite (from) to (to) /o J <br /> Inspector: Grout (from) lot (to) O <br /> Drilling rig type 3� <br /> Permit No. � Q 3f Auger O.D. IS;, ee J& I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Comp <br /> afny: <br /> Driller: / /Z.,/ d Z V casing <br /> height <br /> Consultant �( - <br /> *Geologist <br /> (7 ABOVE-GROUNDCOMPLETION ���/y <br /> SPECIAL PERMIT INFO. c r� SuA <br /> t O � OJ <br /> Distance to sewer line 770 proof <br /> Domestic well on site - ( y <br /> if yes, location and distance - <br /> c <br /> SAMPLING slotted = ' <br /> section �_ _ •*. . <br /> Holding Temperature = gravel Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> I . <br /> SPOILS / 102 <br /> Storage Method ( Q_ oA � MATERIALS/DEVELOPME <br /> Contamination Noted - ( y ,� .2 < < <br /> Storage Location Casing type <br /> Blank Cos fr. Screen <br /> Slot size 010 <br /> GROUTING Bags cement <br /> Buckets bentonite — Tk 310 <br /> Depth to water ~^ Bags sand/gravel <br /> Mix Ratios 0 7a Filter Pack type/size t L. <br /> Installation Method Surge Block: - ( yn <br /> Quantity Installed Discussed with ge gist: - ( y <br /> Type of method _ <br /> EH 29 29 <br /> 1 ' 6r09 At(llZC ce � 6 Ula <br />