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%w.wONITORING WELL INSTALLATION REPOh,.,00' <br /> Date: CONSTRUCTION <br /> Premise Address:_ _ t�!//-J/1,1? Total Depth <br /> Screen Length (from) 07 (to) <br /> Well No.: /!l Filter Pack (from) (to) <br /> Bentonite (from) (to) 5,S <br /> Inspector: Grout (from) s, -s (to) C7�' <br /> Drilling rig type C SU <br /> Permit No. ,� - ./f Auger O.D. <br /> / l Completion - t epi Christie box (circle one) <br /> Drilling Company: A� l G:y v�h <br /> Driller: casing <br /> height <br /> Consultant _WVT <br /> Geologist AI&E-GROUND <br /> COMPLETION CHRISTY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface + <br /> grout <br /> Distance to sewer line f / <br /> Domestic well on site - (y <br /> If yes, location and distance - <br /> O <br /> C <br /> C <br /> SAMPLING slotted = c <br /> tiCOon <br /> Holding Temperature Vis; - gravel pack <br /> Method <br /> Screening Method —_ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS / <br /> Storage Method o !/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type L/ <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING / Bags cement <br /> 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 /> Type of method <br />