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0 0 <br /> MONITORING WELL INSTALLATION REPOnf <br /> Date: c -1 II O T TT�� /f CONSTRUCTION <br /> �Premise Address: /5 /` Total Depth /00 <br /> Screen Length (from) /6 a (to) <br /> Well No.: �'/ - Filter Pack (from) /06 (to) 'J <br /> Bentonite (from) 7 (to) & <br /> Inspector: '6� Grout (from) ((yy�� (to) 4tL <br /> Drilling rig type oto <br /> Permit No. Auger O.D. I.D. 4 <br /> 4Ground <br /> pipe/christie box (circle one) <br /> Drilling Company: r� <br /> Driller: Y, � / sing <br /> fight <br /> Consultant —WW <br /> GeologistCHRSTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. S�iCt <br /> Distance to sewer line PER <br /> grout <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - 73 ft. <br /> Pic' L., <br /> SAMPLING 1~ M`� 1slottad = $ <br /> wc5on <br /> Holding Temperature VA pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method �i G� (r/ "~ MATERIALS/DEVELOPMENT <br /> Contamination Noted(y/ n ) ;7I' PUC <br /> Storage Location Casing type— <br /> Blank--ft <br /> ypeBlankft. [Screen ft. <br /> Slot size . V 20 <br /> GROUTING Bags cement <br /> n Buckets bentonite / <br /> ap <br /> Depth to water = bs Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 1 Z <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> (:9 �'/� <br />