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1 <br /> 1` <br /> MONITORING WELL INSTALLATION REP- KT <br /> d��2 Z rd�J CONSTRUCTION <br /> Date: P / <br /> Premise Address:�? &vL& ' (&4, Total Depth <br /> Screen Length (from) Cto) <br /> Well No,: Filter Paco (from) Cto) <br /> Bentonite (from) Cto) <br /> Grout (from) Cto) <br /> Inspector. Drilling rig type <br /> Permit No. Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan <br /> y: <br /> casiag <br /> Dalley. ISA ( height <br /> Consultant -K Gd't' IM <br /> __ <br /> a <br /> Geologist /ABOVE-GRCUNO <br /> CC&F Z=N U-6iI5^! 0X <br /> 3 <br /> COWL=i CN <br /> Ground Skxf� <br /> SPECIAL PERMIT INFO, 'T-- <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y / n ) !t. <br /> If yes, location and distance - ft <br /> . a <br /> SAMPC3NG i10 <br /> sateen <br /> Holding Temperature ."nom pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / a ) <br /> SPOILS <br /> i <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank fc Screen fT- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water.LBagssand/ <br /> Mix Ratios Filter Pack typelsize <br /> Installation Method g Surge Block - / a ) <br /> Quantity Installed Discussed with geologist - ( y / a ) <br /> Type of method <br /> EH 29 29 <br />