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MONITORING WELL INSTALLATION REPOtc f <br /> Date: l 3 .C) ��� CONSTRUCTION <br /> Premise Address: <br /> JV'/6 Total Depth <br /> p Screen Length (from) O (to) 0 <br /> Well No.: Ifo Filter Pack (from) (to) y�•�" <br /> Bentonite (from) 1_-(60— -(to) <br /> Inspector: Grout (from) -G _(to) a <br /> Drilling rig type _ <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: I <br /> , <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist . <br /> Ai;vr:-GROUND <br /> COMPLETION CNRiSTY 80X <br /> COIAPLE71ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line / Grout <br /> Domestic well on site - (y n <br /> If yes, location and distance - .G <br /> ft. <br /> - b <br /> C <br /> SAMPLING <br /> slotted � <br /> a sacdon — <br /> Holding Temper <br /> gn <br /> Method — V&YW P <br /> ack <br /> Screening Method <br /> Tracking Sheet - y n ) <br /> SPOILS •/ <br /> Storage Method f Ly�sq MATERIALS/J;EVELOPMENT <br /> Contamination Noted - (y/n ) Q,, / <br /> Storage Location M /11. 7 SE GdL�c.t� Casing type � 10 `T Y o <br /> Blank . ft. Screen 20 ft. <br /> Slot size <br /> GROUTING Bags cement fff ✓ <br /> ? Buckets bentonite t�nJti <br /> Depth to water w Bags sand/gravel 6006 <br /> Mix Ratios 0- Z Filter Pack type/size ' <br /> Installation Method Surge Block: - (y CD <br /> Quantity Installed Discussed withgeolg8ist: - On) <br /> Type of method rV4 <br /> EH 29 29 <br />