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4ONITORING WELL INSTALLATION REPT <br /> Date: y /, FJ CONSTRUCTION <br /> Premise Address: / �'L,�ttGl' 7U � Z �(p•T .y�. Total Depth � <br /> ��//� Screen Length (from) (to) <br /> Well No.:— Filter Pack (from) (to) <br /> Bentonite (from) (to)�_ <br /> Inspector: Grout (from) (to) tL <br /> QZG '41- <br /> Drilling rig type -/ <br /> Permit No. O� �JAuger O.D. I I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> 3 <br /> Driller: case g <br /> �,�heigh <br /> Consultant [ L <br /> Geologist � VA-'t•�( <br /> Mi0V -GACUND CNA75rY-80X <br /> COMPLErX) CCMPLE110N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line �/Q grout <br /> Domestic well on site - (D n ) ti <br /> If yes, location and distance - ft. <br /> SAMPLING dotted <br /> tec9on <br /> Holding Temperature = 9,iyol pa,* <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method�� lig 4." MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location Casing type <br /> Blank ? ft. Screen 15 ft. <br /> Slot size .024D <br /> GROUTING Bags cement <br /> Buckets bentonite C"&� <br /> Depth to water *• Bags sand/gravel ' 7 <br /> Mix Ratios Filter Pack type/size :0 3, <br /> Installation Method Surge Block: - (D n ) <br /> Quantity Installed Discussed with geologist: - ( yn <br /> Type of method - <br /> 2929 <br /> /J 0 -6 - <br /> o <br /> � � 9 <br />