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`. .NITORING WELL INSTALLATION REPO <br /> Datel I lZgZ;Ye CONSTRUCTION <br /> Premise Address:LZ 7c1*7 / p Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> /�/ Bentonite (from) (to) <br /> Inspector: v-+ �i�aa Q� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> Consultant he_ght� <br /> Geologist_ <br /> ABOVE-GACUND <br /> COWLETON Ct AlSTY 80X <br /> CCMPL`RICN <br /> SPECIAL PERMIT INFO. Ground Surfaoa <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) It, <br /> if yes, location and distance - ft. <br /> h. <br /> = m <br /> = m <br /> SAMPLING <br /> aecicn <br /> Holding Temperature <br /> Method — vivo,racx <br /> Screening Method r; <br /> Tracking Sheet - (y/ n ) — <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <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 <br />