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'MONITORING WELL INSTALLATION REPOItr' <br /> Date: �p ' `� CONSTRUCTION <br /> Premise Address: Total Depth_ i2�� <br /> Screen Length (from) (to) <br /> Well No.: mbJ lq/ Filter Pack (from) _(to) <br /> n' Bentonite (from) (to) <br /> Inspector: � 9�N Grout (from) (to) I <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion - Stove pipe istie box ircle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �1lA,l '4' —QWT <br /> Geologist <br /> ABOVE-GRCUND CNRtSTY-BOX • <br /> COMPLETION COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground Surface T1; <br /> T t <br /> Distance to sewer line Orcut 25 t 4ve wl <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - "ftp 4 <br /> 43 n, 3 _ 40 ns-- 4LS i5 P(PfN <br /> ^A' O <br /> v?• M <br /> SAMPLING slotted <br /> a9,cicn <br /> Holding Temperature 4% = Yw <br /> Method ' - F z <br /> Screening Method 17 r <br /> Tracking Sheet - n) <br /> (CO, �n. .._..._. ce 3' f. <br /> SPOILS <br /> Storage Method �1W"" , MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location b 116 Casing type 40 f V C/ <br /> Blank ft. a Screen 20 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite -V,-Lfw�— <br /> Depth to water V Ba an avel <br /> Mix Ratios �(�l _ ke !4 LU F ter ack type/size <br /> Installation Methods Surge Block: - (y <br /> Quantity Installed Discussed with geologist: 7eO/ n) <br /> Type of method qtr al <br /> EH 29 29 <br />