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.MONITORING WELL INSTALLATION REPS. _ _ ! ` F� <br /> ,i V e' S <br /> J <br /> Date: I / .� �� p I CONSTRUCTION <br /> Premise Address : // S 3 P [AJ� b YVUe Total Depth <br /> Screen Length (from) / (to) <br /> Well No. : M l4 Filter Pack (from) /P- (to) Z <br /> Bentonite (from) 1 (to) 01 <br /> Inspector: Grout (from).t (to)kf <br /> trilling rig type b C <br /> Permit No. / 7 Auger O.D. YT We <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �r� � <br /> Driller: casing _— <br /> he ±ght <br /> Consultant <br /> Geologist <br /> ABOVEGROUND CHAISTYBOX <br /> COfviPl ETION coMPLE7IC <br /> SPECIAL PERMIT INFO. Ground Surfw <br /> Distance to sewer line grout <br /> Domestic well on site - y rt ) <br /> If yes, location and dista ce <br /> 3 ft. ft. <br /> _ <br /> SAMPLING donad <br /> lUfrl 17� ( k�t � IS socticn <br /> Holding Temperature <br /> Method = <br /> Screening Method :r <br /> Tracking Sheet - ( y / n ) <br /> ft. <br /> SPOILS <br /> Storage Method �Jt,( _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - 01vo 4/ y <br /> Storage Location 6k —Sw � " Or w/! c p/ t.�t t.e� Casing type <br /> � U Blank 3 ft. Screen <br /> Slot siz <br /> GROUTING Bags cement N <br /> f{ Buckets bentonite t S <br /> Depth to water 8 * Bags sand/gravel <br /> i Mix Rados Filter Pack type/ ize Q <br /> Installation Methoda malt/ Surge Block: - �/ n ) <br /> Quantity Installed 41Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />