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MONITORING WELL INSTALLATION REP%��- <br /> Date: /1(7 CONSTRUCTION <br /> Premise Address: ZZZ� - e:f' Total Depth 677 <br /> Screen Length (from) _(to) <br /> Well No.: Filter Pack (from) (to) <br /> /� / Bentonite (from) 5-9�(to)�— <br /> Inspector: ^-td Grout (from) CJ (to) <br /> � <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> l✓ / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �n^ v✓ <br /> Geologist ABOVE-GROUND <br /> COMPLETION CY-BOX <br /> COOMPLMPLETION <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line Lt:: gra <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - tt <br /> — c <br /> — o <br /> SAMPLING slatted _ 'E <br /> taction k — <br /> Holding Teperature L �, ? <br /> gravel pack <br /> Method ; <br /> Screening Method /- <br /> Tracking Sheet -Oy <br /> n) <br /> SPOILS f <br /> Storage Method 5 `' � "� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water S Bags sand/gravel <br /> Mix Ratios n 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 />