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ONITORING WELL INSTALLATION REPO <br /> Date: l/ /Q� CONSTRUCTION <br /> A646 k+ <br /> Premise Address: Total Depth 30 <br /> Well No.: Screen Length (from) 30 <br /> (Sd� / Filter Pack (from) 3 %�j (to) _ <br /> �K Bentonite (from) 3 (to) 1 <br /> Inspector: Grout Upipe/christie <br /> (to) <br /> Drilling rig <br /> Permit No. Auger O.D. I.D. <br /> DrIlling: Campany: 1 " 1.4 Completion CompletionM- StEove b x (circle one) <br /> Driller: casing <br /> Consultant <br /> height <br /> Geologist r <br /> ABOVEGROUND <br /> COMPLEf ON CHRISNY BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> - Ground Surface <br /> Distance to sewer line J �� grout (ir ea-rne}� <br /> Domestic well on site - ( y / n ) y <br /> If yes, location and distance <br /> T7� <br /> SAMPLING = a <br /> Waited <br /> iacdon <br /> Holding Temperature <br /> Method ENV <br /> Screening MethodTracking Sheet - ( y / n <br /> SPOILS <br /> Storage Method `+`^ LC. f MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) S E jp <br /> Storage Location Casing type_ 20 A/S t�kj D <br /> Blank 5 ft. Screen ZX' <br /> ft. <br /> Slot size OZb <br /> GROUTING Bags cement <br /> Buckets bentoniteak <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size (Z <br /> Installation Method Surge Block: - ( y / <br /> Quantity Installed Discussed with geologist: - n ) <br /> EH 29 29 Type of Method <br />