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I0-MONITORING WELL INSTALLATION REPj <br /> Date:_ (b CONSTRUCTION <br /> Premise Address: r " �d� Total Depth o <br /> 33 Screen Length (from) I IN <br /> Well No.: Filter Pack (from)–i 21, (to) 85 <br /> Bentonite (from) ISS (to) 19 9, <br /> Inspector: Grout (from) (to) <br /> Drilling rig type_ � <br /> Permit No. d Auger O.D. I II.D. <br /> n Compled ve pi christie box (circle one) <br /> Drilling Company: T rDs 0711 k c. <br /> Driller: --"- casing <br /> CL m height <br /> Consultant T <br /> Geologist �� c�tin L5 - T <br /> A80UND CiSISTY-BOX <br /> COMPLETI6PLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su ian <br /> Distance to sewer line groLd <br /> Domestic well on site - (y/ n) <br /> ft' <br /> If yes, location and distance - JS <br /> I0 ftft. <br /> _ - m <br /> — e <br /> = e <br /> SAMPLING sloped <br /> &scion <br /> Holding Temperature <br /> Method = gravel Pack <br /> Screening Method = <br /> _ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) It <br /> Storage Location Casing type r V <br /> Blank ft. Screen I0 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 /> EH 29 29 <br />