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rv10NITORING WELL INSTALLATION REPOni <br /> Date: �W N 1�� ��TIO 7 CONSTRUCTION <br /> Premise Address: P 591L Total Depth ` 5 <br /> ,rr Screen Length (from) 71 (to) <br /> Well No.: N' Filter Pack (from) 737 (to) 65 <br /> Bentonite (from) (0 9 (to) t7— . <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 52 J�Sro Auger O.D. & I.D. <br /> ^ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ( � �' Q <br /> Driller: -r7 ' casing <br /> height <br /> Consultant n_ ' <br /> Geologist '�✓d - r <br /> ABOVE-GROUND JCHR!ZMr!Y43OX <br /> COWLETION <br /> SPECIAL PERMIT INFO. Grand Su tate <br /> ? <br /> Distance to sewer line grout <br /> Domestic well on site - (yn ) Z ft <br /> If yes, location and d'stance <br /> _ a <br /> — m <br /> — n <br /> - m <br /> SAMPLING $totted = $ <br /> IV-6P $ec6on <br /> Holding Temperature � = gravel tack <br /> Method — <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS - T <br /> Storage Method Q,� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y / „ ^ � <br /> Storage Location u�d . dr"� Casing type y Q f ( 7 U <br /> Blank ft. 8creen ft. <br /> Slot size O'1 <br /> GROUTING Bags cement (13 <br /> r Buckets bentonite 2 3t) <br /> Depth to water Thi Bags sand/gravel �S'O <br /> Mix Ratios •F 4o o Q Filter Pack type/size 7i{7� <br /> Installation Methoa Surge Block: - (y/ n ) <br /> Quantity Installed 55t 3D 3b Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />