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J <br /> rwONITORING WELL INSTALLATION REPOn <br /> M1;s <br /> r, Date: CONSTRUCTION <br /> Premise Address: �/ Total Depth <br /> Screen Length (from) (to <br /> Well No.: e, '3 Filter Pack (from) <br /> _ Bentonite (from) (to) <br /> F Inspector: Grout (from) ST`f_(to) Q <br /> osSS <br /> Drilling rig type <br /> Permit No. ✓.J �s Auger O.D. I.D. <br /> `a Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: .74-, J casing <br /> height <br /> Consultan aG& f <br /> Geologist <br /> ABOVE-GROUND - <br /> COWLETION G-[RM rY-$OX <br /> r COMPLETION <br /> SPECIAL PERMIT INFO. t3=nd Sur w* #� AFL !f <br /> e 3 <br /> Distance to sewer lin <br /> -/ M 3a v� 3z -r 9�0� <br /> Domestic well on site - y n ). ` ft. <br /> If yes, location and distance - <br /> oc <br /> SAMPLING slotted <br /> Holding Temperature gmys,Pack <br /> Method ' _ <br /> Screening Method - l ' _ •= .� <br /> *• Tracking Sheet - (y/ n ) <br /> .t <br /> spolLs �, cwt� Z: ' <br /> Storage Method !/_�"- MATERIALS/DEVELOPMENT <br /> Contamination Noted - C y 06h <br /> Storage Location ;z __ _ ~ ` Casing type' le <br /> Blank/LO ,,y1/L__— ft. Screen <br /> aur r 4 Slot size �i[J <br /> GROUTING` ."b., ._. ,�,� * ,c Bags cement <br /> Buckets bentonitey <br /> ti ' z eAr-A <br /> Aq <br /> Depth to water - �3 Bzg"and/graveI <br /> Mix Ratios iV •-P Itow Filter Pack type/size 3 <br /> Installation M thod 04at,,t Surge Block: - (y <br /> 4 Quantity Installed ZS 3 -P -/i ti 4 Discussed with geo ogist: - (y �n <br /> Type of method <br />