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`,dONITORING WELL INSTALLATION REP(. <br /> Date: o l U CONSTRUCTION <br /> Premise Address: s MAC- Total Depth <br /> Screen Length (from) (to) <br /> Well No.: w ( r ` Filter Pack (from) (to) <br /> Bentonite (from) 62 (to) S <br /> Inspector: Grout (from) 5 (to) <br /> Drilling rig type LJ4 .e,_.J .344%* L <br /> ^ <br /> Permit No. Auger O.D. I.D. <br /> � \ Completio pipe ove chrisrie box (circle one) <br /> Drilling Company: <br /> Driller: V t casing <br /> height —ev <br /> Consultant S <br /> Geologist k W 1'kv� ." <br /> ABOVE-GROUND CHRISTY480X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface r��• <br /> Distance to sewer line grout <br /> Domestic well on site y n) <br /> If yes, location and ist e <br /> SAMPLING P slotted _ E <br /> sec•Son <br /> Holding Temperature <br /> gravel <br /> Method "` _ P <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) (( 1 <br /> . r G <br /> Storage Location Casing type v <br /> Blank l7 ft. Screen ioft. <br /> Slot size <br /> GROUTING Bags cement 1^� <br /> Buckets bentonite I <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (9/ n ) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />