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MONITORING WELL INSTALLATION REPOnt <br /> Date: <br /> ��� 3�S CONSTRUCTION <br /> l�t <br /> Premise Address: 9fos Total Depth `/ <br /> c Screen Length (from) (to)i <br /> Well No.: Filter Pack (from) (to) <br /> s� Bentonite (from) l (to <br /> Inspector: Grout (from) t(o (to) a <br /> Drilling rig type <br /> Permit No. rT ` Auger O.D. <br /> �� Completion - Stove pipe/christie box (circle one) <br /> Drilling Compannyy: <br /> Driller: / f 1 casing <br /> Ttl height <br /> Consultant6fi <br /> Geologist ABOVE-GROUND <br /> COMPLETION COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ���Ground Surface <br /> >5v ' grout <br /> Distance to sewer line /6 tt <br /> Domestic well on site - (y n <br /> If yes, location and distance - j ft. <br /> SAMPLING <br /> — m <br /> _ o <br /> _ m <br /> — o <br /> SAMPLING dotted = $ <br /> wc5on <br /> Holding Temper ture = gravel Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet y n ) <br /> SPOILS <br /> Storage Methodt- y <br /> ' d+t A-Y' -5f02101MATERIALS DEVELOPMENT <br /> Contamination Notedn 6It Cv 16 <br /> Storage LocationtLtt�c !rte Casing type <br /> Blank ZU ft. � Screen 2 5 ft. <br /> Slot size .0-513 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> ;z Depth to water ," Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz g� <br /> Installation Method Surge Block: - y n) <br /> Quantity Installed Discussed with geologist: - (y n <br /> Type of method �oG <br /> EH 29 29 <br /> ew'/ <br />