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MONITORING WELL INSTALLATION REPOt l-' <br /> Date: iZ�I}l0 7 99 �q CONSTRUCTION <br /> �"L vZ t 1. �'H^4`�q r a®4 44 <br /> Premise Address: Total Depth = �/`i•C� /"^'7�!) _ <br /> Screen Length (from)--- (to)�— <br /> Well No.: S • 2. • 95 Filter Pack (from) (to) '75' 3" <br /> Bentonite (from) ' (to) <br /> Inspector: _ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. Iro I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �� <br /> Driller: !�r/! �^ 1/' --ffcc�� casing <br /> height <br /> Consultant ,�'''// + •�• <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETIONN <br /> COMPL_EnON <br /> SPECIAL PERMIT INFO. Ground Surtacro <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 3 ft. <br /> — a <br /> = m <br /> m <br /> - m <br /> SAMPLING slonad _ B <br /> saclon - —_ <br /> Holding Temperature /'�'� = ImvW Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - n 1 /4,Y" <br /> SPOILS q',� Q0 a <br /> Storage Method p -V��/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location 34/ eAlx�— gA� Casing type I i>V L _ ScV\ <br /> Blank� fr. Screen-19—ft. <br /> Slot size o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo gist: - (y <br /> Type of method <br /> EH 29 29 <br /> /L/713 <br />