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MONITORING WELL INSTALLATION REPbl" <br /> Date: �' _ 7 CONSTRUCTION <br /> Premise Address: Z1G 9�a� Total Depth 3s- <br /> Screen Length (from) (to) 20 <br /> Well No.: /ZZ�I/l/Z f �3 Filter Pack (from) (to) 19 <br /> Bentonite (from) (to) 110 <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Sic 4�.31 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: '44 casing <br /> . height , <br /> Consultant <br /> Geologist .. <br /> ABOVE-GROUND <br /> COMPLETION C�iAISTY-80X <br /> SPECIAL PERMIT INFO. Ground Sur wo 7 -- <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> ft. <br /> A <br /> C <br /> SAMPLING _ <br /> slotted ,, � <br /> aacdon — <br /> Holding Temperature _ P <br /> ack <br /> Method '— <br /> Screening Method <br /> Tracking Sheet - (y/ n ) �. <br /> -35 ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location ,,v� l(d.-� � Casing type rr nk 1�0 /9V <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement r Z- <br /> Buckets bentonite `Depth to to water 2-5 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method r` Surge Block: - (y/ n) <br /> Quantity Installed rio Qe,a Discussed with ge tst: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />