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MONITORING WELL INSTALLATION REPOnf <br /> Date: �/�///�0 CONSTRUCTION <br /> Premise Address: W /o° '� �/��` '� Total Depth_ r <br /> 6 b Screen Length (from)_ ri <br /> Well No.: Filter Pack (from) /g�) (to) 53 <br /> Bentonite (from)_ (to)W_ <br /> Inspector: Grout (from) (to) 3 <br /> S� � 3 Drilling rig type ljx r t 7 <br /> Permit No. Auger O.D. I.D. <br /> Drilling _ „c Completion - Stove pipe/christie box (c cle one) <br /> Company: c//!,/��"`� <br /> Driller:_ �V"� t/�{�te- �C/P/ <br /> casing <br /> Consultant L height <br /> Geologist cjk-'�d)' _ 7 T <br /> ABOVE-GRCUND <br /> CCKPLETION C-HRZTY-BOX <br /> SPECIAL PERMIT INFO. Gmund 3uriCOMPLETION <br /> acs <br /> Distance to sewer line 4-.5o grout <br /> Domestic well on site - ( y/ n <br /> If yes, location and distance - 9 " ft. <br /> h. ft- <br /> = m <br /> = m <br /> SAMPLING ilo ad — 0 <br /> Holding Temperature /.��7�7' G /� 7moo <br /> Method — V%V'W Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> 5� ft. = F n <br /> SPOILS <br /> Storage Method MATERIALS/9EVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type 2 <br /> Blank ft. Screen fr. <br /> Slot size_ 0!o <br /> GROUTING Bags cement A S5 <br /> Buckets bentonite <br /> Depth to water /i Bags sand/gravel 22 <br /> Mix Ratios I Filter Pack type/size 2 tz <br /> Installation Meth d Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y jQ ) <br /> Type of method <br /> E/29 <br /> M /T S d g <br />