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MONITORING WELL INSTALLATION REPOn f <br /> 'r <br /> (D � <br /> Date: l� 7i�I 011 CONSTRUCTION <br /> Premise Address: D Total Depth Wo <br /> Screen Length (from) 1(o U -:(to) 'sJ� <br /> Well No.: / Filter Pack (from) 1 (e0 (to) 20 <br /> Bentonite (from) 2-0 (to) I L <br /> Inspector: Grout (from) (to) <br /> /� ��q Drilling rig type 7 &0 <br /> Permit No. �1 / Auger O.D. /0' I.D. <br /> Drilling Company: i <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: lw/� casing <br /> /SCE <br /> Consultant height <br /> .` <br /> Geologist ( /r—, � ' �! - T <br /> ABOVE-GROUND <br /> COMPLETION CHR STY-BOX <br /> COMPLETIO <br /> SPECIAL PERMIT INFO. Ground Saiac� <br /> Distance to sewer line Al Ori <br /> Domestic well on site - CPn ) <br /> If yes, location and distance - �� <br /> '..Jft. _ <br /> e <br /> C <br /> SAMPLING = <br /> slotted = �c <br /> Bacton <br /> Holding Temperature N1A <br /> Method VIVVI Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> I1�o ft. = n <br /> SPOILS t 6 Cl � � <br /> 2' <br /> Storage Method .0 MENT <br /> Contamination Noted- (y/n ) <br /> Storage Location Casing type <br /> 46 <br /> Blank 13o ft. Screen3o ftft <br /> Slot size . O"j(� <br /> GROUTING Bags cement 1t <br /> Buckets bentonite <br /> Depth to water ` 110 Bags sand/gravel Qn <br /> Mix Ratios Filter Pack type/size 1(o L.5 <br /> Installation Method Surge Block: - (y 4�T) <br /> Quantity Installed Discussed with geologist: - (y G)) <br /> Type of method <br /> EH 29 29 <br /> v/o/25,Z4J?,ep5 E <br /> l — <br />