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r��fONITORING WELL INSTALLATION REP ' <br /> Date: ! CONSTRUCTION <br /> Premise Address: &47) Total Depth SJS <br /> Screen Length (from) (to) <br /> Well No.: /%ZN/� /! Filter Pack (from)- 55—(to) <br /> Bentonite (from) (to) 3 <br /> Inspector: Grout (from)—(to) O <br /> (�G Drilling rig type a$-,& 7-5- <br /> 5 .J <br /> Permit No. d 0 Auger O.D. Sa I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: /�ltL A c%E casing <br /> height <br /> Consultant — / G� <br /> Geologist /e-u <br /> ABOVE-GROUND CHAISTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) n <br /> If yes, location and distance - n <br /> = m <br /> — o <br /> SAMPLING nlor ad <br /> wc7on <br /> Holding Temperature = ,Vival Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS `L <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) —9— <br /> ( Q V-0 <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size U!U <br /> GROUTING Bags cement LU <br /> Buckets bentonite <br /> Depth to water = 3� Bags sand/gravel <br /> Mix Ratios O/C Filter Pack type/size <br /> InstallationMeth8a Surge Block: - (y� <br /> Quantity Installed Discussed with ge st: - (yn) <br /> Type of method <br /> EH 29 29 <br />