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MONITORING WELL INSTALLATION REPOnf <br /> Date: CONSTRUCTION <br /> Premise Address: //�' u�z ��i�'�/ �w� Total Depth <br /> `� G Screen Length (from) Z (to) <br /> Well No.: 11 Filter Pack (from) S- (to) 2. s <br /> Bentonite (from) 2• S (to) 0. <br /> Inspector: �' L Grout (from) (to) U <br /> Drilling rig type S <br /> Permit No. Auger O.D. $• I.D. <br /> Completion - Stove pipe/christie box circle one) <br /> Drilling Company: <br /> Driller:��t �, casing <br /> / height <br /> Consultant <br /> Geologist - <br /> ABOVE-GROUND <br /> COMPLETION �Si 1 <br /> C ON <br /> SPECIAL PERMIT INFO. + Ground SuAxt <br /> ? <br /> Distance to sewer line ° grout <br /> Domestic well on site - .7 n ) Q.sll <br /> If yes, location and distance -� �� ,IL 4z. : SL5 <br /> — a <br /> o <br /> = m <br /> C — o <br /> SAMPLING Blood = c <br /> o - - sacdon <br /> Holding Tempe ture C. _ 7zvWp� <br /> Method S � � <br /> Screening Method = <br /> Tracking Sheet - y n ) ��] C, <br /> J_� <br /> SPOILS1S' <br /> Storage Method MATERIALS/DEVELOPMENTCC` <br /> Contamination Ngted - (y/ )� Z �f . <br /> Storage Location t S+�l is J(1) Casing type <br /> Blank S fr. Screen 2 1 2�L <br /> 2 <br /> Slot size 0Zb g• •� <br /> GROUTING Bags cement <br /> t Buckets bentonite + - R30 <br /> Depth to water Bags sand/gravel <br /> Mix Rados ( t t °0 Filter Pack type/size "I <br /> Installation Method Surge Block: - (y C7n <br /> Quantity Installed Discussed with gec ogg'�t: - (y n) <br /> Type of method Nl�t <br /> EH 29 29 <br /> + <br />