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MONITORING WELL INSTALLATION REP <br /> 7 nn <br /> Date: m��� CONSTRUCTION mL <br /> .r. <br /> q 1 <br /> Premise Address: a l Total Depth 3 z) <br /> rn0 � Screen Length (from) ('0) <br /> Well No.: a� Filter Pack (from) (to) _ <br /> I 5 % Bentonite (from) —(to) / <br /> Inspector. ,(e/u i i) 5;4"Grout (from) (O (to) /Jtl <br /> 66 'Drilling rig type �nr1 i�, ,cu4 _ <br /> Permit No. Auger O.D. Z" LD. <br /> Completion - Stove pipe/ tsti`e fox` ircle one) <br /> Drilling Company: <br /> Driller: ti casing <br /> height <br /> ConsultantAJj b� 4 <br /> Geologist VVTABCVE-GRCUND <br /> OCMPLE ICN CXR* Y-dOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground su f <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> ft. <br /> R. <br /> = m <br /> = c <br /> SAMPLING = —' <br /> donsd — c <br /> tecicn — <br /> Holding Temperature <br /> Method — VIVW Pa:k <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) " P <br /> n I <br /> Storage Location Casing type c� t' <br /> Blank ft. Screen ft. <br /> '^ Slot size <br /> GROUTING Y 1 Bags cement <br /> U 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 />