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MONITORING WELL INSTALLATION REPOT f <br /> Date: /C�� T� LOD l > CONSTRUCTION <br /> Premise Address: I/2 <br /> Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 2 Filter Pack (from) 715 (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) = 2ys <br /> `j�'/ Drilling rig type 7 <br /> Permit No. Auger O.D. (() I.D. (o <br /> �f Completion - Stove pipe/chHstie box (circle one) <br /> Drilling Company: /..�—�j1��_ <br /> Driller: Ae/tt 7-c Z c sing <br /> / he ght <br /> Consultant <br /> Geologist T <br /> A <br /> BOVE-GROUND <br /> T{O C4HRISTY4= <br /> COMPLET CN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ~ 50 P grout <br /> Domestic well on site - ( y(D 5'15 - ft <br /> If yes, location and distance - 3�5 <br /> ft. <br /> ft. - <br /> = o <br /> O <br /> C <br /> SAMPLING = c <br /> slotted � c <br /> Holding Temperature (�1� <br /> Method = <br /> va V4 Pack <br /> Screening Method —_ <br /> Tracking Sheet - ( y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n ) Poe <br /> Blank-_: <br /> Storage Location Oh /PU Casing type <br /> Blank 6 t Z— ft. Screen <br /> Slot size <br /> GROUTING �31A4Bags cement <br /> Buckets bentonite <br /> Depth to water % Bags sand/gravel <br /> Mix Ratios S/ Zfi 4 Filter Pack type/size <br /> Installation Methodt"lel <br /> Surge Block: ( y/ n <br /> Quantity Installed Discussed with geo ogist: - ( y/ no <br /> ? Type of method <br /> EH 29 29 <br />