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VNITORING WELL INSTALLATION REPGn <br /> �n p <br /> Dater 0 CONSTRUCTIC,g�, r <br /> Premise Address: Total Depth <br /> Screen Length (from) (to)_ <br /> Well No.: ,� g Filter Pack (from)—(to)-- <br /> Bentonite <br /> from) (to)_Bentonite (from) (to) <br /> Inspector: Grout (from) (to)_ <br /> 53 Drilling rig type <br /> Permit No. o Auger O.D. I.D. <br /> y £ / Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan/y: Gf/ <br /> casing <br /> height <br /> Consultant <br /> r <br /> Geologist A80VE-GROUND <br /> COMPLETION COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. 6u1 <br /> �Ce grout <br /> Distance to sewer line <br /> Domestic well on site - (v/ n ) tt. <br /> If yes, location and df 1^^ tt l (t. <br /> a <br /> SAMPLING slotted — g <br /> &action <br /> Holding Temperati = Gni PaCK <br /> Method l wc-/S — <br /> Screening Method ^:Tracking Sheet - �QT /�/I'— 25 p72,111 Zso <br /> SPOILS 1 <br /> Storage Metho� MATE ALS VE ,OP T 0 <br /> Contamination {71/�i <br /> ft <br /> Storage Location Casing type <br /> Blank 4� ft.v Screen 3� <br /> Slot sizK) — <br /> GROUTINGAI*Bags cement <br /> rp� Buckets bentonite ' L �2•fd ly0ra.✓i� <br /> Depth to water ri / 4 " Bags sand/gravel DV <br /> Mix Ratios f� NAP /t/ f Filter Pack type/size ✓L <br /> Installation Method- �awti L� Surge Block: - Un ) .Vt <br /> Quantity Installed Discussed with geologist: - (y �n 1 <br /> Type of method <br /> EH 29 29 <br />