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IONITORING WELL INSTALLATION REPO..,,' <br /> Date: �( /7 7 CONSTRUCTION <br /> Premise Address:/U& Total Depth ° <br /> Screen Length (from) 0 (to) L D <br /> Well No.: Jud " Filter Pack (from) 30 _(to) 8 <br /> Bentonite (from) (to) (o <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D.1�, <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 5�S <br /> Driller: casing <br /> height <br /> Consultant A 6-6 <br /> 7, <br /> Geologist L t� -5 <br /> ABOVE-GROUND <br /> COMPLETION CNAtSTY-80X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) n <br /> If yes, location and distance - <br /> _L°ft. ft. <br /> _ a <br /> SAMPLING dotted <br /> �oL tiec5on <br /> Holding Temperature _ gravel Pack <br /> Method 1_tu f — <br /> Screening Method = <br /> Tracking Sheet ( y/ n ) _ <br /> IF 36 ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type �t' ��� <br /> Blank c 0 ft. Screen <br /> Slot size '0 . 02-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y/�D <br /> Quantity Installed Discussed with geologist: -r/ n ) <br /> Type of method <br /> EH 29 29 <br />