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MONITORING WELL INSTALLATION REPO <br /> Date: Lp- CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) Z (to) I <br /> Well No.: Filter Pack (from) 24 (to) (-7-- <br /> Bentonite <br /> zBentonite (from) 12 (to) q <br /> Inspector: �1 AIA�h Grout (from) (to) I <br /> Drilling rig type <br /> Permit No. Auger O.D. 10 Y G <br /> Drilling Company: 11II,�L'1?iZ� <br /> M Completion - Stove pipe/ sue box (circle one) <br /> Driller: UI7iV casing <br /> height <br /> Consultant ��l L�1 r tUd —QW–f <br /> Geologist ABOVE-GROUND <br /> COMPLETION CHRZIY-BOX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground 3urfan <br /> s <br /> Distance to sewer line RR <br /> ,tot io <br /> Domestic well on site - (y/ ) <br /> If yes, location and distance ft. <br /> ft. <br /> — a <br /> = m <br /> 0 <br /> = c <br /> — o <br /> SAMPLING slotted <br /> / <br /> an ' — <br /> Holding Temperature = 9MV91Pack <br /> Method — <br /> Screening Method =_ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method (16, 4 MATERIALS/DEVELOPMENT / <br /> Contamination Noted - ( y/ ) / <br /> Storage Location 6p� yl 11f Casing type 5( �� <br /> Blank 6 ft. Screen IS ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite ti 'rl <br /> Depth to water / Bags sand/gravel <br /> Mix Ratios Filter Pack type/ 'ze <br /> Installation Method Surge Block:/ n ) <br /> Quantity Installed Discussed with geologist: -19 n ) <br /> Type of method V I . <br /> EH 29 29 <br />