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MONITORING WELL INSTALLATION REP...-�T <br /> Date: CONSTRUCTION <br /> Premise Address: �L "" U` Total Depth�S <br /> Screen Length (from) (to) <br /> Well No.: W I Filter Pack (from) I (to) l0 8 <br /> Bentonite (from) ��$ (to) <br /> Inspector: Grout (from)-(to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 1 .11'14 I.D. 9 " S N <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height —QW-f <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND CHRISTY4= <br /> I COWL.ETbN CCMPLETICN <br /> SPECIAL PERMIT INFO. plt» Ground S <br /> Distance to sewer line U' proof <br /> Domestic well on site - (y/ n ) 4`/�" ;o _ �i - S6, 6 ft. <br /> If yes, location and distance - ft. <br /> ft. D <br /> — a <br /> = m <br /> — o <br /> SAMPLING slansd _ B <br /> s�c5on —_ <br /> Holding Temperature /w" gravel pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 'II[r <br /> Storage Location Casing type PUC- T <br /> Blank D ft. ScreenIS ft. <br /> Slot size 0.010 <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/ <br /> Quantity Installed Discussed with geologist: - (Cy/ n ) <br /> Type of method <br /> EH 29 29 <br />