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MONITORING WELL INSTALLATION REPO <br /> CONSTRUCTION <br /> Premise Address: Total Depth d <br /> �/ Screen Length (from) (to) <br /> Well No.: .2-1C2�y�y tle ( 01 �" Filter Pack (from) (to) <br /> �.iSAY Bentonite (from) (to) <br /> Inspector: �� Y Grout (from) to) <br /> Drilling rig type ,(/LcRtO3 <br /> Permit No. Auger O.D. « 3// I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> . w.�-car( <br /> Driller: casing <br /> height <br /> Consultant � '4 <br /> Geologist T <br /> ABOVE-GACUND Ct6i15TY80X <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground g49fxy <br /> Distance to sewer line 7roul <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> tt. _ <br /> N�. <br /> O <br /> O <br /> O <br /> SAMPLING <br /> slorad <br /> tacicn <br /> Holding Temperature <br /> Method — <br /> Screening Method : =_ <br /> Tracking Sheet • (y/ n ) <br /> SPOILS 2 p ., <br /> Storage Method lY A6 1�b d MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) <br /> Storage Location Casing type <br /> Blank ft Screen V ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Z 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 omethod <br /> EH 29 29 <br />