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MONITORING WELL INSTALLATION :rr5!'ORT <br /> Date: `� p c, CONSTRUCTION <br /> Premise Address: Z` Po," 0� S Total Depth `6 <br /> Screen Length (from) �t (to)_ k-.5 ' <br /> Well No.: YV1 %A1 - Filter Pack (from) 3- 3 (to). r.�S _ <br /> Bentonite (from) 3- ( (to)_ <br /> Inspector: 11.6 Grout (from) le (to)__ g <br /> Drilling rig type <br /> Permit No. 574 �� Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> _' <br /> Driller: J " t /t 5O <br /> Q � height casing <br /> Consultant_ � p A{Vie' l f <br /> ABO VE-G A Cl1N D <br /> CO VF LET{O N CHR ISTY-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Around Suixe <br /> Distance to sewer line <br /> grout <br /> Domestic well on site y/ n ) _r <br /> If yes, location distance - <br /> . _ft. P <br /> q <br /> 9 <br /> SAMPLING _— o <br /> Clotted _ c <br /> &tea cn — <br /> Holding Temperature — <br /> Method <br /> Screening Me;.4d = <br /> Trackin eet - ( y/ n ) — <br /> — _ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - UY n ) <br /> Storage Location Casing type L PV <br /> Blank_ :1 s; ft. Screen <br /> Slot size o D ZO <br /> GROUTING Bags cement <br /> Depth to water <br /> Buckets bentonite <br /> Mix Ratios — Bags sand/gravel %: --,—a k/r., <br /> Filter Pack type/size <br /> Installation Method _ Surge Block: - ( y/U) <br /> Quantity Installed <br /> Discussed with geologist: - ( y/0 <br /> EH 29 29 Type of method <br /> T T7- <br /> 9 <br />