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MONITORING WELL INSTALLATION REPOAI <br /> Date: Il 16 D� 1 A"Zi;.ea. f CONSTRUCTION <br /> Premise Address: 1 D06 Ui - Total Depth 6U <br /> Screen Length (from) 7 (to) <br /> Well No.: Filter Pack (from) (00 (to) <br /> Bentonite (from) (to) S2 . <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. TX d 53 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_T <br /> Driller: 2f&:u7tw1 z � casing <br /> height <br /> Consultant /4- i <br /> —TIM pz;f— <br /> Geologist <br /> ABOVE-GROUND CONFLE CN iiOON <br /> SPECIAL PERMIT INFO. Ground S xlxa <br /> Distance to sewer line e So grout <br /> Domestic well on site - ( yDn <br /> If yes, location and distance - SS ft. <br /> ft. <br /> N <br /> - O <br /> - C <br /> SAMPLING slotted = c <br /> . / &action =_ - <br /> Holding Temperature gravel pack <br /> Method Sr = <br /> Screening Method P/D "t? _ ;•' <br /> Tracking Sheet n ) _ > <br /> SPOILS <br /> Storage Method IAL-f tr•ilu I/�q MATERIALS/DEVELOPMENT <br /> Contamination Noted -(W n ) <br /> Storage Location,61d /DD/yp,– Casing type i <br /> �µe��� Blank 5!v ft. Screen-2—ft. <br /> Slot size 0)0" <br /> GROUTING Bagscement 8flfT 'Fz. <br /> Buckets bentonite !/q <br /> rr <br /> Depth to water ?j5 Bags sand/gravel / <br /> Mix Ratios �n,.D + T M-y 7Filter Pack type/size Z <br /> Installation Method •w &cx, :2 Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 45- �� <br />