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vow VOW <br /> MONITORING WELL INSTALLATION REPOni <br /> Date: &L i i CONSTRUCTION <br /> Premise Address: /27WTotal Depth ZG <br /> Screen Length (from) Zdi (to) Lo <br /> Well No.: Filter Pack (from)__ 27� (to)� <br /> Bentonite (from) I (to) <br /> Inspector: Grout (from) (o (to) 3 <br /> sn 52/x(3 Drilling rig type <br /> Permit No. Auger O.D. os I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: J ►� f L casing <br /> E height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION ii <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surtan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> n. <br /> If yes, location and distance - <br /> Win. <br /> n. <br /> - m <br /> SAMPLING slo — c <br /> wcdon <br /> Holding TemperaturegmvW= P <br /> ack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/n ) _ <br /> SPOILS 24 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location d Casing type 2 PUG <br /> Blank 20 ft. Screen <br /> Slot size j10 <br /> O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water — Bags sand/gravel L <br /> Mix Ratios Filter Pack type/size ZI <br /> Installation Method Surge Block: - (y e5D <br /> Quantity Installed Discussed with geologist: - (y A0 <br /> Type of method <br /> EH 29 29 <br /> 11- <br />