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` TVIONITORING WELL INSTALLATION REPOtrr <br /> Date: CONSTRUCTION <br /> Premise Address: Z ! Total Depth <br /> Screen Length (from) d (to) <br /> Well No.: Filter Pack (from) 400 (to) 77 <br /> Bentonite (from) � (to) 9-/ <br /> Inspector: Grout (from) a ( (to) / <br /> Drilling rig type .5 <br /> - <br /> Permit No. ^y6�-�7 0 y Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: � - '��'� casing <br /> height <br /> Consultant31 <br /> Geologist ABOVE-GROUND <br /> S7 - OX <br /> PLTICONFLETION <br /> T <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 2 <br /> Distance to sewer line �fO`n <br /> Domestic well on site - ( y n S� <br /> If yes, location and distance - � ft. <br /> ft. <br /> _ a <br /> C <br /> O <br /> SAMPLING slotted = ; <br /> sacl�on _ <br /> Holding Temperature = „� <br /> Method <br /> Screening Method = ` <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type — --/ <br /> Blank ft. Screen '5� ft. <br /> Slot size 100 <br /> GROUTING Bags eenTMr <br /> 1 Buckets bentonite 7;r— <br /> Depth to water // Bags sand/gravel <br /> Mix Ratios GRT f7 Filter Pack type/size 7Z <br /> Installation Method Surge Block: - ( y n <br /> Quantity Installed 4 V4yi Discussed with geologist: ( y <br /> Type of method <br /> EH 29 29 <br />