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QvIONITORING WELL INSTALLATION REPOR'' <br /> Date: /��0� CONSTRUCTION <br /> 4 <br /> Premise Addrgss: l� V Total Depth <br /> �b Screen Length (from) /09 (to) 9 <br /> Well No.: x �� Filter Pack (from) O. (to) <br /> Bentonite (from) s— (to) <br /> Inspector: Grout (from) (to) O <br /> Drilling rig type CA4,. 7S <br /> Permit No. Auger O.D. g I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 0 casing <br /> / .height <br /> Consultant �e.��� -�• <br /> Geologist j` / - T <br /> ABOVEGROUND CHAISTY-80X <br /> ..I�MP�TbN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sumac* <br /> 3 <br /> Distance to sewer line h L <br /> grout <br /> Domestic well on site - ('y 9T <br /> If yes, location and distance - ft. <br /> _Lft. n. <br /> = m <br /> a <br /> o <br /> slotted <br /> ted _ 8 <br /> 1 wcoon <br /> Holding Temperature / C gr1vW Pack <br /> Method <br /> j Screening Method <br /> Tracking Sheet - (y/ n) <br /> �ft. ft. <br /> SPOILS <br /> Storage Method ljsljMATERIALS/DEVELOPMENT <br /> Contamination Noted - ('y CD 2,r / �C <br /> p <br /> Storage Location O x n, tk Casing type <br /> Blank ft. Screen /O ft. <br /> Slot size . DJ.O" <br /> GROUTING Bags cement = elk <br /> Buckets bentonite �'/Dl✓ Cda'i c <br /> Depth to water 37 Bags sand/gravel O <br /> Mix Ratios " SE° h Filter Pack type/size -2-1(17— <br /> Installation <br /> 1z- <br /> Installation Method Surge Block: - (y A ]) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of <br /> I EH 29 29 <br />