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40NITORING WELL INSTALLATION REPOn'i� <br /> Date: /, CONSTRUCTION <br /> Premise Address: /ooh W� Total Depth 40 <br /> Screen Length (from) 5F (to)_S <br /> Well No.: 45 -2,9 Filter Pack (from) co (to) 5 <br /> / Bentonite (from) (to) 35/ <br /> Inspector: Grout (from) S f (to) 3 <br /> y�Ps3 Drilling rig type C-. 6 7S <br /> Pennit No. Auger O.D. C I.D. <br /> Qo_ Completion - Stove pipe/christie box (circle one) <br /> Drilling Compaannyy: �d�Pf iLu w- <br /> Driller: /(�G(L /4/42c. casing <br /> a ' height <br /> Consultant /i`'i� <br /> Geologist �ypyt <br /> /ABOVE-GROUND <br /> COMPLETION CHMM-BOX <br /> COMPLEnO <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line x.50 grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - <br /> — a <br /> = m <br /> C <br /> SAMPLING slotad <br /> tecdon = <br /> Holding Temperature (i-4pv f(0- (oU <br /> VIV1W Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS (p a <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 1( <br /> Storage Location Casing type Z V(- <br /> Blank T ft. Screen 3 ft. <br /> Slot size 0/o <br /> GROUTING Bags cement PF /0 y7li'*01& - <br /> 2 Buckets bentonite z <br /> Depth to water " !Z Bags sand/gravel -f77- <br /> Mix <br /> zMix Ratios 3t)en Pyr t Filter Pack type/size 2 r Z <br /> Installation Method -AVmr Surge Block: - (y n <br /> Quantity Installed $$t'SS r 5,0 Discussed with geoist: - (y� <br /> Type of method <br /> EH 29 29 <br /> /bl f 11t11-7S Z9 <br />