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IONITORING WELL INSTALLATION REPOnI' <br /> Date: Z,4 <br /> 6 CONSTRUCTION <br /> Premise Address: ��Od �. Total Depth <br /> Screen Length (from) 6PO (to) <br /> Well No.: '45 Filter Pack (from) (to) <br /> Bentonite (from)--- (to) S <br /> Inspector: Grout (from) <br /> Drilling rig type CAU1E 7 <br /> Permit No. ra 3 Auger O.D. it I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: . � casing <br /> 9 <br /> Consultant C 'L19 <br /> Geologist J�w /���� - 7 T <br /> ABOVE-GROUND CHRLM-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Gond Surlaos <br /> Distance to sewer line So gfout <br /> Domestic well on site - ( y/ n ) 1 6V h <br /> If yes, location and distance - <br /> = m <br /> — e <br /> = m <br /> — � o <br /> SAMPLING cloud = <br /> 7 /U/Ol// wctlon <br /> Holding Temperature = 72,E pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) f — <br /> 690 ft. <br /> SPOILS .t— <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type l� <br /> Blank ft. Screen_3ft. <br /> Slot size D/D <br /> GROUTING Bags cement /0-- <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 8-/O Z9 30 eA Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed 55-r Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> /L-lkl6 145 - 2, 3 <br />