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MONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUC'T'ION <br /> Premise Address: Total Depth, <br /> � qq Screen Length (from) r (to) -30 <br /> Well No.: W Filter Pack (from) -3 (to) <br /> Bentonite (from), Za -(to) <br /> Inspector. Grout (from) 7-6- —(to)� <br /> Z � 3 *0 Drilling rig type _ <br /> Permit No. <br /> Auger O.D. I.D. <br /> �- Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> �C �� Y. Z / _ casing <br /> Driller: <br /> n he-;ghc <br /> Consultant A- 1 4f. <br /> Geologistd N� <br /> t,��s k.•-•f �a,�-��-�- �sav>=-��cur�� crwcsr�r�Ox <br /> 'a aCl���sok Con��EnC <br /> SPECIAL PERMIT INFO. G=rd SLrlact <br /> Distance to sewer line prrcn <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - It_ <br /> 4" O <br /> r <br /> SAMPLING <br /> io-cicn — � <br /> Holding Temperature = <br /> Method = pavdFadc <br /> Screening Method 'c <br /> Tracking Shcet - ( y/ n ) _ <br /> ft. 7� <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - (y/ n ) . r-Vr <br /> Storage Location Casing type 1 L� <br /> Blank !3 ft- Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Depth to water �- 'IfBuckets bentonite - J <br /> Z�,5 53 graYcl <br /> Mix Ratios TUTUIIX& type/size ' V1 <br /> Installation Method Surge Block: - ( y/ 11 ) d <br /> Quantity Installed Discussed with geologist: -_ (-y/ n } <br /> EH 29 29 Type of method <br />