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iviONITORING WELL INSTALLATION REPOh <br /> Date: A�v CONSTRUCTION <br /> Premise Address:- 'ZA�/ ��/� ��- ��1, �— Total Depth_ 2-5-6 Screen Length (from) - (to) l S <br /> Well No.: Filter Pack (from) ZS (to) <br /> Bentonite (from) (to) <br /> Inspector: _ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �L v�/ Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �` O casing <br /> height <br /> Consultant <br /> Geologist 7,1 <br /> ABOVE-GROUND <br /> OOMPLETION O zrr <br /> ON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> F / <br /> Distance to sewer line 7 f aro`l <br /> Domestic well on site ( y n <br /> If yes, location and distance - ft. <br /> L•S ft. <br /> -E <br /> m <br /> SAMPLING slottad = c <br /> 0 soc5on <br /> Holding Temperatur C-• <br /> pack <br /> Method = �Y91 <br /> Screening Method &j Y1 =_ <br /> Tracking Sheet <br /> ft. = " ft. <br /> SPOILS <br /> Storage Method �> Ute - MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) 0 Y <br /> Storage Location Casing type �J <br /> ?V <br /> Blank ft. Screen 10 ft. <br /> Slot size O 1 <br /> GROUTING Bags cement <br /> 7 Buckets bentonite <br /> Depth to water Bags sand/gravel 3�5 <br /> Mix Ratios Filter Pack type/size L �z <br /> Installation Method Surge Block: - (y/ n <br /> Quantity Installed Discussed with geo ogist: - ( y' fJ <br /> Type of method <br /> EH 29 29 <br />