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•MONITORING WELL INSTALLATION REPOR'C <br /> /0/6� <br /> Date: CONSTRUCTION <br /> ?7 <br /> Premise Address: J( 7tt' J�WTotal Depth Jd <br /> Screen Length (from) -�Q (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cltristie box (circle one) <br /> Drilling Company: <br /> Driller: �^ _ casing <br /> - " r height <br /> - d.11 7 <br /> Consultantl / <br /> .....1�w <br /> Geologist <br /> ABCVE-GACUND Ct1AlSTY 30X <br /> COA�LETK�N COMPLETION <br /> SPECIAL PERMIT INFO. Ground&ataca <br /> VX <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> ft. <br /> _ a <br /> _ m <br /> w <br /> SAMPLING alorai = E <br /> � <br /> auricn <br /> Holding Temperature = gaud Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> _ ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ nyP y) _ / r�b <br /> Storage Location Casing type ' PCL -L <br /> Slot size <br /> Screen Z fr. <br /> Slot size (7.� <br /> GROUTING Bags cement <br /> 1 Buckets bentonite <br /> Depth to waterlIAZ � Bags sand/gravel_ <br /> Mix Ratios Filter Pack type/size >It <br /> Installation Method Surge Block: - (y/ n <br /> Quantity Installed Discussed with geo ogist: -,t'y/ n ) <br /> Type of method V <br /> EH 29 29 <br />