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PONITORING WELL INSTALLATION REPOn <br /> Date: "wl //yea`( �/� �P� ee±:o�G CONSTRUCTION <br /> Premise Address:!2v/ "J 'AIA A Total Depth <br /> Screen Length (from)—(to)— <br /> Well <br /> from) (to)Well No.: Filter Pack (from) (to) <br /> Bentonite (from)—(to)— <br /> Inspector: <br /> from) (to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> n J Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: lli <br /> Driller. � casing <br /> p height <br /> Consultant L`/l —W, <br /> Geologist <br /> A80V <br /> COMPLETION <br /> CHRZTY-80X <br /> COMPLETbN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Six* <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) IR/ s `a <br /> If yes, location and distance - L ft. <br /> e = o <br /> � = r <br /> SAMPLING S plotted = � <br /> tec5on <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2n <br /> Storage Location Casing type IOv(L <br /> Blank ft. Screen ft. <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 /> 11.1;-f1 <br /> 1 "010 <br />