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MONITORING WELL INSTALLATION REPOn f <br /> Dale : CONSTRUCTION <br /> Premise Address: � � �/3G Total Depth � 3 <br /> �� f / Screen Length (from) (to) <br /> Well No. : Filter Pack (from) Z3 (to) <br /> Bentonite (from) (to) <br />` Inspector: Grout (from) (to) 0 <br /> Drilling rig type <br /> Permit No, �c 7 J � s / Auger O.D. 10 I.D. to <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: � ' y a >1 / s casing <br /> height <br /> Consultant <br /> Geologist CS <br /> ABOVE-GROUND CS-S STY-BOX <br /> COA+� LETION COMPLETIO , <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 7 <br />` Distance to sewer line grout <br /> Domestic well on site - ( yn <br /> If yes, location and distance - <br /> OO tt <br /> n. <br /> SAMPLING aloud = _ <br /> O tac�on <br /> Holding Tempe turegravoo= PaCK <br /> Method_ G�x CDLP <br /> Screening Method W� <br /> Tracking Sheet 6yn ) 23 <br /> tt. tt- <br /> SPOILS <br /> Storage Method f LliuO v� MATERIALS/DEVELOPMENT <br /> I <br /> Contamination Noted - y n ) .1 _ <br /> Storage Location /`fCe uut!-ol Casing type / dU ` `TCS I V <br /> Blank ft, Screen IS ft• <br /> Slot size a? (b <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water 7t:, Bags sand/gravel i <br /> Mix Ratios Filter Pack type/size 9' U <br /> Installation Method Surge Block: - ( y4!D n <br /> Quantity Installed Discussed with geologist: - ( yam <br /> Type of method <br /> EH 29 29 <br />