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N <br /> N MONITORING WELL INSTALLATION REPORT <br /> Date:4 � 1 CONSTRUCTION <br /> Premise Address: b b I {n, L Total Depth <br /> � 1 ` �' Screen Length (from) (to) <br /> Well No.: Uln * � 3 � � � ' 3 Filter Pack (from) (to) <br /> II11 p 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: casing <br /> height <br /> Consultant.c7- ftA ' Q/" <br /> _ Iro A80VEGACUND <br /> Geologist <br /> COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ©round Surface <br /> Distance to sewer line Grout <br /> Domestic well on site • ( y / n ) 7 It. <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> SAMPLING <br /> 0 <br /> cloned — c <br /> socion <br /> Holding Temperature Ravoa F <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y / n ) m <br /> lie <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type a" pjc)- oh <br /> Blank ft. Screen 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 />