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�iONITORING WELL INSTALLATION REPO-~w <br /> Date: D CONSTRUCTION <br /> Premise Address:_ � -��, Total Depth <br /> TT nn Screen Length (from) (to) <br /> Well No.: !�� Filter Pack (from) (to)--7-5- - <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) / (to)�— <br /> {� �Z Drilling rig type L P• '�* 75 <br /> Permit No. 49" Auger O.D. A) I.D. (11 <br /> Drilling <br /> /I i / Completion - Stove pipe/christie box (circle one) <br /> Company: (�%'�! <br /> Driller: ~ O'1 /�// casing &WX <br /> heightConsultant /'1�v GeologistABOVE-GROUNDCOWFLEfION C <br /> SPECIAL PERMIT INFO. Ground Sufws <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) // ft <br /> If yes, location and distance - g n. <br /> O <br /> SAMPLING <br /> siotwd x' � <br /> aacdon X• — <br /> Holding Temperature <br /> VavW <br /> Method " _ - D <br /> ack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) A A � � D�J <br /> Storage Location Casing type )` ` <br /> Blank /5 ft. r Screen fr. <br /> Slot size D 3 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel '� <br /> Mix Ratios — Filter Pack type/s1 e <br /> Installation Method Surge Block: - y n ) <br /> Quantity Installed Discussed with geologist: - ( y - <br /> Type of method <br /> EH 29 29 <br /> / �t <br />