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400NITORING WELL INSTALLATION REPO* <br /> Date: 4 O CONSTRUCTION <br /> Premise Address: Total Depth 1 Z <br /> Well No.: Screen Length (from) d (to) <br /> Filter Pack (from) (to) <br /> Ij-� V Bentonite (from) Z. (to) <br /> Inspector. - - Grout (from) (to) Z <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. .Z <br /> Drilling Company: <br /> �, n;l Completion - ove pi christie box (circle one) <br /> Y �LL�� U r �' Vb VI/1� <br /> Driller: Y <br /> •1♦ TT casing <br /> Consultant CY / w rr./ height <br /> � lti <br /> ABOVE-GROUND <br /> COMPLETION Q-SL TY-BOX <br /> SRECIAL PERMIT INFO. Ground SuCOMPLETION <br /> Surface <br /> Distance sewer line Qrart <br /> Domestic we site - (y/n ) Z <br /> If yes, location an istance - l ( ft <br /> ft. ft. <br /> m <br /> SAMPLI — o` <br /> �bttad — c <br /> sac5on <br /> Holding Tempera — <br /> Method 4n. = gravel pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y In �0 ` � <br /> Storage Location Casing a <br /> Blank ft. Screen 20 ft. <br /> Slot size Q i6 <br /> GROUTING Bags cement <br /> Buckets bentonite_ <br /> Depth to water Bags sand/g&vel_ L 9 <br /> Mix Ratios Filter Pack e ize� vV R <br /> Installation Method Surge Blo n ) <br /> Quantity Installed Discussed with o ogist: - (y <br /> EH 29 29 ) <br /> Type of method <br />