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mONITORING WELL INSTALLATION REPOk.. <br /> Date: 1, 1' CONSTRUCTION <br /> Premise Address: 101TI LInLA k/ Total Depth <br /> Screen Length (from) 14�) (to) <br /> Well No.: �� ISS Filter Pack (from) L(a D (to) <br /> Bentonite (from) t34-5 (to) 111 .S <br /> Inspector: l�c% Grout (from) t''5I '57 (to)�ff� � <br /> Drilling rig type — <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ,,1�7/1� <br /> Driller: �ON\Ic sing <br /> T h fight <br /> Consultan a" Il'iuJ �/I IV V <br /> / ._ <br /> Geologist -r--- ABC CUND <br /> I�t.:"TION Ci-�itSSY-�X <br /> COWL_E C1CN <br /> SPECIAL PERMIT INFO. Grouc�d Sufacs <br /> Distance to sewer line / <br /> Domestic well on site - ( y/ n ) - -ft. <br /> ifyes, location and distance - <br /> 0 <br /> _ a <br /> -- c <br /> - o <br /> SAMPLING <br /> ween — <br /> Holding Temperaack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ e <br /> SPOILS <br /> Storage Method 11110 �� MATERIALS/DEVELOPMENT <br /> r � <br /> Contamination Noted (` / n ) 11W I <br /> ming type M N11M\.Q �o `� h� Sl•tJ <br /> Storage Location fr <br /> ^, m� Blank ft Screen <br /> Slot size _ <br /> GROUTING B�grr t <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geol st: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />