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',,,,JNITORING WELL INSTALLATION REPO...,, <br /> Date: 9f 3Df�7 CONSTRUCTION <br /> Premise Address: &;M5' N �'aGf!/ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> l Bentonite (from) (to) <br /> Inspector: s T�"� S1, Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> s { L��rn/ Completion - Stove pipe/clu�istie box (circle one) <br /> , 'D Jl <br /> Driller: casing <br /> height <br /> Consultant Gl/•S 7�lih�Yo� ���a��� <br /> Geologist ���� yh T <br /> ABOVE-GRCUND CHMM-80X <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Swface ��• <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/n) �d ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> _ o <br /> SAMPLING slot'.ad <br /> socdcn -" <br /> Holding Temperature �- <br /> Method l C-e- �h /!.c :a: _ ¢s"al Pack <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method `�SG "' MATERIALS/DEVELOPMENT <br /> Contamination Noted n) <br /> Storage Location Casing type <br /> Blank ft. Screen 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 geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />