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MONITORING WELL INSTALLATION REP&f <br /> Date: /�# �Q ��9 CONSTRUCTION <br /> Depth <br /> Premise Address: �S Total De p , <br /> Screen LenItype <br /> om) (to) 2 <br /> Well No.: Filter Packm) (to) <br /> Bentoniteom) (to) S <br /> Inspector: Grout m) (to) 1� <br /> Drilling rigPermit No. J 7 Auger O.D. ZOO' I.D. <br /> ��� Completion-Stove pipe/christie box (circle one) <br /> Drilling Company: . <br /> Driller: casing <br /> height <br /> Consultant <br /> —0441 T <br /> Geologist <br /> ABO vE-Ga OLONQ ,1�'�,,r�` CHRIS r-box <br /> COMPLETION�I '►}' COMPLETION <br /> SPECIAL PERMIT INFO. Z nd Surf <br /> grout <br /> ? c ut <br /> Distance to sewer line �5 <br /> Domestic well on site - (y n n• <br /> If yes, location and distance - ft• <br /> r. <br /> i.. O <br /> t•- O <br /> Z. C <br /> �• y O <br /> SAMPLING slotted <br /> socdon f <br /> Holding Temperature = _ <br /> Method pack <br /> Screening Method _ <br /> Tracking Sheet - (y/n) <br /> n <br /> SPOILS )rs S(rem �) / :112 V1. D b <br /> Storage Method D►t MATERIALS/DEVELOP� <br /> Contamination Noted - y/ n ) <br /> Storage Location- •�Gc Casing type <br /> Blank 9/Yt- ft. Screen S ft• <br /> Slot size <br /> . <br /> GROUTING Bags cement <br /> TI ?dt/ !'l <br /> Buckets bentonite - I.X 30 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios = !Z041`f- 7`"3 o Filter Pack type/size Z <br /> Installation Method Surge Block: - (y� <br /> Quantity Installed S t U NO 7-! Discussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 <br />