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f0ONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: /DOd 461. � 0�ee� Total Depth IVO <br /> �A`` T— Screen Length (from)_ 58 <br /> Well No.: 16- - /� _(to) S$ <br /> Filter Pack (from) 60 (to) 5 <br /> / Bentonite (from) '54 571 <br /> Inspector: �du. � Grout (from) 5 f (to) 3 <br /> DD Y ��J 3 Drilling rig type713'_ Gw..E <br /> Permit No. Auger O.D. I.D. 4 <br /> Completion - Stove pipe/cbristie box (circle one) <br /> Drilling Company: �-- <br /> Driller:—� casing <br /> height <br /> Consultant " " � <br /> Geologist CY <br /> IN <br /> ABOVE-GROUND <br /> CONFLETION CHRISTY&N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y S� ft. <br /> tt <br /> 55 If yes, location and distance - ft. _< ITY <br /> m <br /> SAMPLING slotted _ c <br /> lsQ2 (pG section = <br /> Holding Temperature _ is <br /> Method a' — -` W" tpack <br /> Screening Method M <br /> Tracking Sheet - (y/ n ) -_ <br /> ft. = I IFtt. <br /> SPOILS (o <br /> Storage Method A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y�) <br /> Storage Location Casing type 2 <br /> Blank SS ft. Screen <br /> Slot size rrto'' <br /> GROUTING Bags cement ZS <br /> Buckets bentonite 14 <br /> Depth to water 3 Z Bags sand/gravel 1 tr <br /> Mix Ratios6 ofd -iO ` ri i / Filter Pack type/size L r2 <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed_ SS -r 55 t 20 Discussed with geologist: - (} a <br /> Type of method <br /> EH 29 29 <br /> 1211 / � <br />