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MONITORING WELL INSTALLATION REPO,. f <br /> I <br /> Date: A14 so�- CONSTRUCTION <br /> Premise Address : `l5� Er" Total Depth <br /> Screen Length (from) W (to) 60 <br /> Well No. : Filter Pack (from) 200 (to) <br /> Bentonite (from) $ (to)r . <br /> Inspector: Grout (from) (to) 0 <br /> Drilling rig type I <br /> NCO <br /> Permit No, Auger O.D. !?" I .D. <br /> / <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> �i�/ <br /> Driller. casing <br /> � ✓ l height <br /> Consultant <br /> Geologist <br /> ABOVEGROUND CHRMTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) X n <br /> If yes, location and distance - n <br /> 16 n. <br /> 0 <br /> SAMPLING d <br /> section = $ <br /> Holding Temperature = gra,,dPack <br /> Method =_ <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> SPOILS �J <br /> Storage Method S S 5 MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) 2 ` f 0 /J O�� <br /> Storage Location fJ7 - Awf Casing type <br /> Blank ft. Screen / D ft. <br /> Slot size . D ZO <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 5 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: . ( yn <br /> Quantity Installed Discussed with geo ogist: - ( Y(O <br /> n ) <br /> Type of method <br /> EH 29 29 <br /> .5116 �- 9 <br />