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a s ONITORING WELL INSTALLATION REPO.. <br /> - y <br /> Date: �� �� CONSTRUCTION <br /> .Premise Address: 30/ k/, 1��-�- r� Total Depth <br /> Screen Length (from) (to) <br /> Well No.:_ AV Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: cas ing <br /> height <br /> Consultant <br /> Geologist •- <br /> ABOVE-GROUND CHR*TY-BOX <br /> COMPLETION COMPLETEON <br /> SPECIAL PERMIT`INFO.. ._a Ground Surface <br /> Distance to sewer line _ grout <br /> Domestic well on site - (y/ n ) <br /> if yes, location and distance - . <br /> ft. <br /> ft. <br /> 16 <br /> o <br /> SAMPLING <br /> saclon $ <br /> Holding Temperature <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - {y/ nIF <br /> — <br /> �. a- — <br /> ' <br /> SPOILS <br /> Storage Method 4 MATERIALS/DEVELOPMENT ; <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blanks ft. Screen ft. <br /> ,.: . Slot size' _ , <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> Mix Ratios - y , I 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 , w <br /> 3 <br /> I _ <br />