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00NITORING WELL INSTALLATION REPO <br /> Date: 0 7 CONSTRUCTION <br /> Premise Address: /00d �• 'a Total Depth <br /> ., (y Screen Length (from) (to) <br /> Well No.: � "Ll Filter Pack (from) (to) 5 3 <br /> Bentonite (from) (to) 50 <br /> Inspector: T Grout (from) (to) <br /> Drilling rig type Gft-G 1 S <br /> Permit No. 7 O Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> r� __ <br /> Driller:_ _�(/ 160C. y//e-e casing <br /> ��—� height <br /> Consultant Z.-6t <br /> Geologist (Jo w _ T <br /> ABOVE-GROUND <br /> COMPLETION <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground surtaca <br /> Distance to sewer line �J� grout <br /> Domestic well on site • ( y ,-U ft <br /> If yes, location and distance - <br /> ft. <br /> = m <br /> a <br /> — m <br /> SAMPLING slotted <br /> tactcn <br /> Holding Temperature <br /> vavW <br /> Method = P <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) -f ^^'' <br /> Storage Location Casing type !i S� ` 6 Pye <br /> Blank ft. Screen 3 _ft. <br /> Slot size trr o <br /> GROUTING Bags cement ZS <br /> Buckets bentonite I 2 <br /> Depth to water 31 Bags sand/gravel <br /> Mix Ratios Ole Filter Pack type/size 17— <br /> Installation Method Surge Block: - (y/n <br /> Quantity Installed Discussed with geo st: - (y n ) <br /> Type of method <br /> EH 29 29 <br />