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,wONITORING WELL INSTALLATION REPO., <br /> Date: I ! S CONSTRUCTION <br /> Premise Address: � 1r Total Depth <br /> Screen Length (from) - (to) Z <br /> Well No.: --1q1 10 j 1 Filter Pack (from)_ (to)� <br /> Bentonite (from) (to) <br /> Inspector �' '�y ti Grout (from <br /> Drilling rig type <br /> Permit No. 7-74 ' <br /> 74 Auger O.D. I.D. <br /> ,� ,UCompletion - Stove pipe/c stieTiox ,(circle one) <br /> Drilling Company-__ eJITIT-C� <br /> Driller: casing <br /> height <br /> Consultant � &, g <br /> _ � T <br /> Geologist r � �-tirt� <br /> ABCVE•GROUND <br /> COMPL nCN <br /> SPECIAL PERMIT INFO, Ground Swfact <br /> Distance to sewer line <br /> Domestic well on site - (y/Lip <br /> If yes, location and distance ft. <br /> O <br /> YY. <br /> SAMPLING <br /> Ebro.•! ':. <br /> aactcn <br /> Holding Temperature_ ble& <br /> Method VIVW Pack <br /> Screening Mediod — <br /> C <br /> Tracking Sheet - {y/ n ) <br /> ?� ft. "" _ ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - n <br /> Storage Location Casing type <br /> Blank j Q ft. Screen <br /> Slot size ► t <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water 1 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size rt <br /> Installation Method Surge Block: - ( y/ 11 ) <br /> Quantity Installed Discussed with geologist: - { y/ n j <br /> Type of method <br /> EH 29 29 <br />