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MONITORING WELL INSTALLATION REPO <br /> Date:__ q/ZS/� 7 <br /> CONSTRUCTION <br /> Premise Address: Total Depth_ Z I <br /> M y Screen Length (from) I Z I (to) TOT <br /> Well No.: 1U Filter Pack (from) LA (to) _ <br /> Inspector: Bentonite (from) S (to) <br /> Grout (from) (to)— <br /> Drilling rig type_ K <br /> Permit No. Auger O.D. 9 1 I.D. ((,f <br /> Q Completion - Ove pi a/christie box (circle one) <br /> Drilling Company: w,,o y[p y pQ <br /> Driller: T casing <br /> // '� Y height <br /> Consultant—) �(( � PAY ' i <br /> Geologist Al' de?zr .. <br /> 1/T R80VE-GPOUND <br /> COMPLETION CHRiM--SOX <br /> SPECIAL PERMIT INFO. OCOMPLETION <br /> s rcund Surface <br /> Distance to sewer line oro <br /> Domestic well on site - (y/n) ft <br /> ut <br /> If yes, location and distance - <br /> - <br /> iolftr ;� = - <br /> SAMPLING o` <br /> slottad - — c <br /> uc5on <br /> Holding Temperature — <br /> Method = praval pad <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type Pvc <br /> Blank 00 ft. Screen 2 9 ft. <br /> Slot size_ 17,01 A <br /> GROUTING Bags cement /,$,t") , '— <br /> Cll� S 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 geologist: - (y/n) <br /> EH 29 29 Type of method <br />