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VIONITORING WELL INSTALLATION REPO <br /> Date: 41427—+ CONSTRUCTION <br /> Premise Address: 1' 004 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: `s"� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> �/ <br /> MY Y Drilling rig type <br /> Permit No. / l] Y Auger O.D. I.D. <br /> Drilling Company: <br /> Uti Completion - Stove pipe/christie box (circle one) <br /> / "" "" <br /> Driller: T [ (l'cc� tt—tom casing <br /> T height <br /> Consultant f�/� <br /> Geologist �d.X�/� <br /> AWVE-GROUND CHRISM-BOX <br /> COMPLY f�N COMPLETION <br /> SPECIAL PERMIT INFO. Ground SWI <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) V. qqq <br /> If yes, location and distance - sy tt' <br /> Win. - <br /> n. <br /> = a <br /> = m <br /> I = m <br /> o _ <br /> SAMPLING slotted = c <br /> Holding Temperaturegr&= W pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) 2 // <br /> Storage Location Casing type C <br /> Blank ft. Screen 3 fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> /0� <br />