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TONITORING WELL INSTALLATION REPOn0 <br /> Date: /—,//– O 7 CONSTRUCTION <br /> Premise Address: /00& /✓ Total Depth T <br /> / Screen Length (from) 71 t(to) Z <br /> Well No.: �" 3{7 Filter Pack (from) (to)�_ <br /> Bentonite (from) (to) (p 9 <br /> Inspector: Grout (from) /e Z (to) <br /> q Drilling rig type S <br /> Permit No. �� ! 3�6 Auger O.D. I.D. <br /> Drilling Company:– <br /> l Completion - Stove pipe/christie box (circle one) <br /> ,, � <br /> Driller:/ ' /-- Z casing <br /> Iff T height , <br /> Consultant r�� <br /> 7M FT T <br /> Geologist ( /"� � ._ <br /> 41 ABOVE-GROUND CNAISTI'-BOX <br /> COMPLETION COMPLETIO <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line L J G grout <br /> Domestic well on site - ( y/ n ) 62- . <br /> If yes, location and distance - ft. <br /> ft. <br /> = n <br /> = o <br /> SAMPLING dotted = '{. 0 <br /> wc5on <br /> Holding Temperature gravul pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) / <br /> Lft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) I i D,(C <br /> Storage Location Casing type T V <br /> Blank fr. Screen 3 ft. <br /> Slot size _010 <br /> GROUTING Bags cement <br /> Buckets bentonite I <br /> Depth to water Bags sand/gravel 3 <br /> Mix Ratios Filter Pack type/size 17 <br /> Installation Method Surge Block: - (y/ ) <br /> Quantity Installed Discussed with geo gist: - (y�i <br /> Type of method lJ <br /> EH 29 29 <br /> - 11-07 <br />