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gONITORING WELL INSTALLATION REPO <br /> Date: �7/� //\\ //�� CONSTRUCTION <br /> Premise Address: /� ,Cgl�-�O W ('J Total Depth 6D <br /> ^ Screen Length (from) (to) <br /> Well No.: �yS'/Z Filter Pack (from) 0 (to) — <br /> //ff Bentonite (from) 5 (to) 5'2 <br /> Inspector: `n Grout (from) q2 (to)�— <br /> �5 Drilling rig type 64-1-Aa 7S <br /> Permit No. Auger O.D. Q I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: / casing <br /> height <br /> Consultant L <br /> Geologist <br /> ABOVE-GROUND CHAISTY BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlacs <br /> Distance to sewer line <SO grout <br /> Domestic well on site - (y/ n ) SL tt <br /> If yes, location and distance - <br /> 56 tt, n. <br /> q <br /> O <br /> C <br /> SAMPLING slotted <br /> secton '< — <br /> Holding Temperature_ /� <br /> Method ��P <br /> ack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) 5� <br /> n. <br /> SPOILS /a0 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y%n ) 0 rt n�V� <br /> Storage Location Casing type e 'N <br /> Blank ft. Screen � ft. <br /> Slot size 0 <br /> GROUTING Bags cement Z5 R 4 ,eac <br /> Buckets bentonite �j%2 <br /> Depth to water .31 Bags sand/gravel 3 2. <br /> Mix Ratios 30 e44L4, AO -1:1 <br /> y,ac/lj/ Filter Pack type/size ;/1? <br /> Installation Metho / Surge Block: - (y(n� <br /> Quantity Installed /.3r7 Discussed with geo Op <br /> Type of method <br /> EH 29 29 <br />