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IOONITORING WELL INSTALLATION REPO <br /> Date:— CONSTRUCTION <br /> CCONSTRUCTIONq <br /> Premise Address: r �` O6 �� �� Total Depth 2G Screen Length (from) (to) <br /> Well No.: Filter Pack (from) t U (to) 11 1 <br /> Bentonite (from) !fid (to) 9/1 <br /> Inspector: Grout (from) to) Or <br /> �I �Q <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: %�""'r casing <br /> Consultant <br /> o`er height <br /> Geologist <br /> ABOVEGROUND CtALSTl80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. / Ground Surface <br /> Distance to sewer line Y' grout <br /> Domestic well on site - (y/ n ) 113 ft. <br /> If yes, location and distance - It F ft- <br /> ft. <br /> - m <br /> — o <br /> — m <br /> SAMPLING dottad = c c <br /> Holding Temperature = VzYW pack <br /> Method = __ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Ic( Q_/ Qb Ove <br /> Location Casing type �� .o <br /> Blank /?-U ft. Screen Z6 ft. <br /> Slot size of o <br /> GROUTING Bags cement — <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 17 Filter Pack type/size /Z <br /> Installation Method 4V444 Surge Block: - (y/ n ) <br /> Quantity Installed 1(-1-1] Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />