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MONITORING WELL INSTALLATION REPOrtf <br /> Date: <br /> 2.,&O 6 CONSTRUCTION <br /> X/.Premise Address: �'l �` Total Depth O D <br /> Screen Length (from) a (to) <br /> Well No.: Filter Pack (from) /00 (to) <br /> Bentonite (from) Y- (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type ? <br /> Permit No. Auger O.D. IF I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: _-- <br /> Driller: f14'2V height casing <br /> Consultant __ <br /> Geologist <br /> ABOVE-GROUND <br /> COI�'i`EfION CHFtISTY-80X <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Gaund Surf <br /> Distance to sewer line r]U grout �y <br /> Domestic well on site . <br /> (y d a n. <br /> If yes, location and distanc - , <br /> p <br /> SAMPLING <br /> l 60 Ar <br /> section <br /> Holding Temper VIVII Pack <br /> ,J <br /> Method <br /> Screening Method <br /> s <br /> Tracking Sheet y n ) <br /> rbc) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) yt' <br /> Storage Location Casing type <br /> 46 <br /> Blank ft. Screen ft. <br /> Slat size . C) <br /> GROUTING Bags cement tpot 1. <br /> Buckets bentonite <br /> Depth to water - Bags sand/gravel 46-0 <br /> Mix Ratios $ Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> fi Quantity Installed Discussed with geo ogist: - <br /> R <br /> SH 29 29 Type of method <br /> l��f <br /> Y <br /> �a <br />