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qtONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> ( Screen Length (from) (to) <br /> Well No.: '6 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: —ijGrout (from) (to) <br /> nq nn Drilling rig type <br /> Permit No. "7 � � Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company S <br /> Driller: casing <br /> -T— height <br /> Consultant GJ��- '4 <br /> T <br /> Geologist -- T <br /> ABOVE-GACUND CNAISTY80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. G=nd Surtact <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> R ft. <br /> V' 0 <br /> � V <br /> SAMPLING f r[ <br /> slorai _ <br /> acc'cn <br /> Holding Temperature <br /> Method Vil - _ <br /> ScreeninxMethod u f ;. — <br /> Tracking Sheet yY n ) <br /> ti. = ft. <br /> SPOILS <br /> Storage Method lehAMATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) <br /> Storage Location_ 8 Casing type <br /> Blank ` ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> 6 / Buckets bentonite <br /> Depth to water p Bags sand/gravel <br /> Mix Ratios_ Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ ti ) <br /> Quantity installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />