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',—,MONITORING WELL INSTALLATION REPbr.,T <br /> Date: CI � CONSTRUCTION <br /> Premise Address:YR)1 N, D..l�� Total Depth 33-?S <br /> Screen Length (from) (to) _ <br /> Well No.: (�Z— 3 Filter Pack (from). (to) / _ <br /> Bentonite (from) / - (to) <br /> Inspector: � Grout (from) ! (to), <br /> Drilling rig type rtA-tb -t <br /> Permit No. Auger O.D. YYq I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: L.e.o casing <br /> height <br /> Consultant 07E <br /> Geologist e�--, •- <br /> alT <br /> ABOVE-GROUND <br /> COMPLETION CHRZTY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ 1,p ft. <br /> If yes, location and distance - <br /> = e <br /> = e <br /> SAMPLING sbttad <br /> sac;ion <br /> Holding Temperature <br /> gravol pack <br /> Method /tom <br /> Screening Method Er4 <br /> Tracking Sheer <br /> ft. It-El Irft. <br /> SPOILS nn n <br /> Storage Method r" MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) <br /> Storage Location S AA i& x Casing type 2�'¢'w <br /> Blank__LS S ft. Screen ft. <br /> Slot size 0,02-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ZZ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method k-1- Surge Block: - (y/ n ) <br /> Quantity Installed U Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />