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`MONITORING WELL INSTALLATION REPOn 1 <br /> Date: CONSTRUCTION <br /> Premise Address: 4q Total Depth <br /> / Screen Length (from) (to) 3J U <br /> Well No.: �'�(� Filter Pack (from) (to) 2—J, <br /> Bentonite (from) 21 e (to) Z(- <br /> Inspector: <br /> `Inspector: Grout (from) (to) V <br /> Drilling rig type �-�?S <br /> Permit No. Auger O.D. g I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: � t casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> CAh�PL_�f10N C>iAJS wXX <br /> P <br /> SPECIAL PERMIT INFO. Ground Suixa <br /> Distance to sewer line z5;.6 grout <br /> Domestic well on site - ( y 40 Z� n <br /> If yes, location and distance - 3d ft <br /> ft. <br /> — = m <br /> -- O <br /> O <br /> C <br /> SAMPLING sloCed = x- <br /> Holding Temperature <br /> VIVIW Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> 416 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) C, <br /> Storage Location Casing type <br /> Blank ft. Screen D ft. <br /> Slot size -016 <br /> GROUTING Bags cement 5 47 <br /> Buckets bentonite a0C <br /> Depth to water Bags sand/gravel 3 76 <br /> Mix Ratios — -r Filter Pack type/size /1.-- <br /> Installation Me Surge Block: ( y n <br /> Quantity Installed I<ej Discussed with geologist: - ( y 4Z) <br /> Type of method <br /> EH 29 29 <br /> �o s <br />