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40NITORING WELL INSTALLATION REP(b <br /> Date: 21 D CONSTRUCTION <br /> Premise Address: C7� �i �5h_ 07Total Depth <br /> Screen Length (from) a (to) l <br /> Well No. W �2��GC Filter Pack (from) t0 (to)�— <br /> \n Bentonite (from) (to)— <br /> Inspector. VC \ Grout (from) (to) <br /> rrpp �I Drilling rig type <br /> Permit No. Yt ` �' `g � Auger O.D. 'ZI I.D. <br /> Completio - e/christie box (circle one) <br /> Drilling Company: k W `r `� <br /> Driller: IMGd aY c in <br /> he- <br /> Consultant `.b�'t'� � � —EWT <br /> Geologist <br /> ABCVE-GROUND CtSi M-Box <br /> COWLETC COMPLEMCN <br /> SPECIAL PERMIT INFO. Ground Surtan + —� <br /> 10 <br /> 0th <br /> Distance to server line <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> _ <br /> -• G <br /> O <br /> SAMPLING slornd <br /> soeien —_ <br /> Holding Temperature = yravaiyacst <br /> Method <br /> Screening Method _ =_ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) S <br /> Storage Location Casing type <br /> g Blank t7 ft Screen \o ft- <br /> slot size <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/ n ) <br /> Quantity Installed Discussed with geolnuist: <br /> Type of method e <br /> EH 29 29 <br />