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PONITORING WELL INSTALLATION REPOn' <br /> Date: / 2 CONSTRUCTION Lo <br /> Premise Address: /�C� !rT/r ✓GV// Total Depth ✓u <br /> Screen Length (from) (to) SS <br /> Well No.: Filter Pack (from) (to)— <br /> Bentonite (from) (to) S/ <br /> Inspector: Grout (from) (to) 3 <br /> Drilling rig type f <br /> Permit No. Auger O.D. TC I.D. <br /> n Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 7X � <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist - T <br /> ABOVE-GROUND <br /> COMPLETION IM-BOX <br /> C PLEnON <br /> SPECIAL PERMIT INFO. Grund S{S1ace <br /> Distance to sewer line Qrart <br /> Domestic well on site - ( y/n ) 1 <br /> If yes, location and distance - ft' <br /> ft. <br /> ft. <br /> = m <br /> — o <br /> = m <br /> SAMPLING tlartad <br /> taction — - <br /> Holding Temperature - Vivel Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> A. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) /1 c <br /> Storage Location Casing type <br /> 2" SJ, <br /> h l' <br /> Blank 5' fr. Screen 3 ft. <br /> Slot size 01 0 <br /> GROUTING Bags cement 2$ 7 -aoF4-- <br /> Buckets bentonite -7f/,?- <br /> Depth <br /> 2Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Z i< <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geoogrst: - (y/in <br /> Type of method <br /> EH 29 29 <br /> 1, / - 0'7 <br />