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MONITORING WELL INSTALLATION REPS �tT <br /> I <br /> ' l r <br /> Date: r ( °.. .� ` ter•'.E t►*'' �y'o+�.i 1 I •'. CONSTRUCTION' '-Q1 ' t,I7 <br /> Premise Address f �- ! l Total Depth c�,C .€ i II <br /> M - Screen Length (from) (to) <br /> Well No.: i 1 i ,`"- ',` `'-� (3(-" Filter Pack' { (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) _605- <br /> Drilling <br /> to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> ' Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: J i !t ' 1 <br /> * •� <br /> Driller: cas <br /> ing <br /> height x <br /> Consultant <br /> Geologist •-� `' F„� <br /> .. ABOVE-GROUND <br /> COMPLETION CHRMTY4= <br /> .� . COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfact <br /> Distance to sewer line - grout <br /> Domestic well on`site- {y/ n )E ''i fy. ! ;Y, �'•.; C•' 'p ' t i ! <br /> ft. <br /> If yes, location and distance - <br /> SAMPLING <br /> Holding Temperature p�ys5wre s _ <br /> Method �`� `� Qravol pack .. <br /> r I <br /> # Screening Method Or <br /> Tracking Sheet ( y/n �] n.' �' ``•11�LL`1 �1;- _ <br /> SPOILS <br /> 5 Storage Method MATERIALS/DEVELOPMENT <br /> ` Contamination Noted - (y/ n ) -fP <br /> } Storage Location 1 VkD Casing type <br /> `�` '' ■ , , . GhP4_,r Blank - ft.- Screen <br /> Slot size <br /> GROUTING r ' F � Bags cement r <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3' <br /> {• Installation Method Surge Block: -.(y/n ] <br /> Quantity Installed ` ' • Discussed with geologist: - (y/ n ) <br /> Type of method , <br /> EH 29 29 <br /> 4 <br />