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T <br /> �.;bNITORING WELL INSTALLATION REP <br /> Date: / CONSTRUCTION <br /> _ # <br /> Premie Address: Total Depth ' <br /> Screen Length (from)( (to) <br /> Well No.: I i' 1 Filter Pack (from) (to) 1 <br /> !f �' Bentonite (from) (to) 46 - <br /> Inspector. x : Grout (from) to) <br /> (� " Drilling rig'type i ii <br /> Permit No. -+�- 5 Auger O.D. .D. I <br /> ' - Completion --Stove pipe/christie box '(drele one) <br /> Drilling Company. <br /> Driller:• �}(`i}� Y 1V's ` 7aa Ing <br /> height <br /> o <br /> Consultant t,�nAw, <br /> GeologistL A0 FT #i <br /> y , _ %B�O�Y`EE--GRC�/UND /+HMS}y 3O <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ombd Sufxt <br /> 4i n �F . <br /> 01 <br /> Distance to sewer line Ji�J``[` of0ut <br /> Domestic well on site - (y <br /> If yes, location and distance - :. ' .4# *ft. <br /> {� n. <br /> SAMPLING <br /> ANi <br /> Holding Tem erature `r= f <br /> Methodack <br /> _ `�f% <br /> gnI Screening Method " - <br /> Tracking Sheet - {y n } ' <br /> �...__tt. .tt <br /> SPOILS <br /> I <br /> Storage Method P0 Vd/: _. _ MATERIALS/DEVELOPMENT ,- <br /> Contamination'Noted - L(ygn� q <br /> Storage Location m. Casing type Q <br /> Blank ft. Screen ft. <br /> „. ._ Slot size �.. <br /> GROUTINGi _ Bags cement <br /> ' Buckets bentonite Iih <br /> ' Depth to water r xSD 1 ^R l Bags sand/gravel �> <br /> j Mix Ratios Filter Pack type/siz E <br /> Installation Method_ �Ir1 Surge Block: - (y n <br /> quanti Installed l led - - _ Y Discussed with geo ogist: - y in ) r <br /> t Type of method <br /> EH 29 29 <br /> -36 W I <br /> bhue4 <br />