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MONITORING WELL INSTALLATION REP` <br /> Date: 3 t o CONSTRUCTION <br /> Premise Address: CaS Total Depth 3 o ' s / <br /> M w Screen Length (from) 3D (to) I 'D <br /> Well No.: m(il� Filter Pack (from) 7�, o (to) <br /> Bentonite (from) '3 (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type_. a I 1 e1,t) 5 „� a <br /> Permit No. Auger O.D. I.D. <br /> ^ n /� <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> _ �-aL_ (X <br /> Driller: casing <br /> height , <br /> Consultant "" -� <br /> _q Geologist �+ ._ T <br /> ABOVE-GROUND <br /> COMPLE ;ON CriMM-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. around Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> i a ft ft. <br /> = m <br /> q <br /> C <br /> SAMPLING <br /> slotted � <br /> saaion — <br /> Holding Temperature <br /> Method _ 7-1"Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> 3aSPO _30 — <br /> SPOILS <br /> ILS a , <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type �- <br /> Blank L ft. Screen 20 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 />