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iv10NITORING WELL INSTALLATION REP ' <br /> Date:—/—Z- CONSTRUCTION <br /> Premise Address: A6 Com// Total Depth (,� C <br /> / Screen Length (from) ' 9 (to) 5 6 <br /> Well No.: �J to Filter Pack (from) GO (to)�S <br /> // Bentonite (from) 515 (to) 5.1— <br /> Inspector: <br /> Inspector: Grout (from) 7 (to) 3 <br /> Permit No. OO [ Q Drilling rig type 64u-e- <br /> Auger O.D. ,8— I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: L�- <br /> Driller: casing <br /> IffT <br /> height <br /> Consultant TMT <br /> Geologist _ r <br /> ABOVE-GROUND CHRISTYBOX <br /> COAFLEfION <br /> SPECIAL PERMIT INFO. Ground Surixw <br /> Distance to sewer line SO grout <br /> Domestic well on site - (y n 52- <br /> If yes, location and distance - ft' <br /> sJJ2ft. s, ft. <br /> SAMPLING Ila - c <br /> sac6on = <br /> Holding Temperature <br /> Method <br /> Screening Method = <br /> !�4 <br /> Tracking Sheet - (y/ n) <br /> qft. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Note4n(y/ n) I /lv,p <br /> Storage Location W;L +l 40-0 L14 Casing type Z J <br /> Blank -510 ft. Sgeen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ; 32 Bags sand/gravel <br /> Mix Ratios 60 7• I/ 1 -e-4Filter Pack type/size Z07— <br /> Installation Method rw Surge Block: - (y n <br /> Quantity Installed_ 5 t Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> I-�3�o 45- 5- <br />