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%�NITORING WELL INSTALLATION REPOI,,W <br /> Date: O/j / 93 CONSTRUCTION <br /> Premise Address: Total Depth_ - / <br /> rT Screen Lengthgiki <br /> �y <br /> Well No.: w �'j Filter Pack (to) <br /> )/ Bentonite �a�.�i�� <br /> Inspector: _L �I d1`� _ Grout . <br /> Drilling rig type <br /> Permit No. Auger O.D. P rf <br /> Completion - Stove pip " tie (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> height <br /> Consultant 1er, C Pft'P-,I ih <br /> Geologist did: �/!�!C t� -- <br /> ABCVE-G7CUND jC*MFUE�nCN <br /> ox <br /> CO#&LETION <br /> SPECIAL PERMIT INFO. Ground Sirtace <br /> Distance to sewer line �10Gtyarti� <br /> Domestic well on site - (y/ n ) 1 <br /> If yes, location and distance - tL Y <br /> SAMPLING GW L Bic = <br /> .. _ <br /> Holding Tem erasure 's <br /> Method <br /> Screening Method _ <br /> Tracking Sheet n) <br /> SPOILS <br /> Storage Method o5-T-fmd i1e t S MATERIALS/DEVELOPMENT <br /> Contamination Noted / n u 1l <br /> Storage Location e� i� Casingle / <br /> Blank d ft. Screen '4ft !Z—ft <br /> Slo <br /> fft- <br /> Slot$ize ,!V FZ <br /> GROUTING Flags cement <br /> Buckets bentonite <br /> Depth to water _ Bags sand/gravel -& r <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29:64,,k <br /> r 'if wfvu <br />