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..MONITORING WELL INSTALLATION REPO., <br /> Date: �'n CONSTRUCTION <br /> Premise Address: / �� �'"dVo Total Depth <br /> j Screen Length (from) (to) <br /> Well N � _ /-S �� ^^f^� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant '4 <br /> WGeologist 7//, T <br /> ABOVE-GACUND CNAtSTY-80X <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. around Scrfxs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft- <br /> = m <br /> — o <br /> SAMPLING ,Icro.i <br /> soctcn =_ <br /> Holding Temperature : _ „w <br /> Method = G <br /> Screening Method ;c _ <br /> Tracking Sheet - (y/ n ) <br /> � ft. V — f <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type p <br /> Blank ft. Screen <br /> Slot size 'r <br /> GROUTING Bags cement <br /> r ' Buckets bentonite <br /> Depth to water 67Z ' 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 />