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•ONITORING WELL INSTALLATION REPO <br /> Date: (0—/(,) 'Q O CONSTRUCTION <br /> Premise Address:_ /7ole'060 OG�f /ae-gO Total Depth 75 <br /> Screen Length (from) q0 (to) 0 <br /> Well No.: � Filter Pack (from) :ZI (to)� <br /> Bentonite (from) (to) <br /> Inspector: ( Grout (from) (to) -V2 <br /> Drilling rig type_- - _ — <br /> Permit No. % / Auger O.D. $ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> I(�eight <br /> Consultant <br /> Geologist /�GG(� q — G�/�.^ _ T <br /> ABOVE-GROUND CttA15TYBOX <br /> COMP ION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfaee <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 5-6 <br /> If yes, location and distance - � tL <br /> = m <br /> - O <br /> - O <br /> C <br /> SAMPLING slatted = r'. c <br /> seclon — <br /> Holding Temperature - Vzvgl P <br /> ark <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS75/ �— fR.3o <br /> Storage Method id c-� Lu[t,2 4&-o' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Ztt /QVC <br /> Storage Location Casing type <br /> Blank ft. Screen IO ft. <br /> Slot size .oto" <br /> GROUTING Bags cement <br /> Buckets bentonite 3 �O <br /> Depth to water /= I¢Z Bags sand/gravel DDS <br /> Mix Ratios_ - 17 Ua r a-gox = ISO Filter Pack type/size <br /> Installation Method . Surge Block: - (y/ n ) <br /> Quantity Installed I-so Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> Z9 <br />