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MONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: 6n 1 1 C cy 5D Total Depth <br /> Screen Length (from) (to) <br /> Well No.: �� Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)— <br /> Inspector: Grout (from)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: Y <br /> 2 casing <br /> height <br /> Consultant <br /> Geologist —EFW-T <br /> ABOVE-GROUND <br /> OO&FLETION CHRSTY-BOX <br /> SPECIAL PERMIT INFO. Ground B <br /> urlace COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - � 70 ft. <br /> LCLft. ft. <br /> _= m <br /> m <br /> - m <br /> SAMPLING slatted = c <br /> aecicn <br /> Holding Temperature <br /> Method — 7"'Wpack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) �/ <br /> Storage Location Casing type_ Z �t �Y e/� <br /> Blank 2-,I—ft. Sc en h. <br /> Slot size • 0 10 <br /> GROUTING Bags cement $ t/' <br /> Buckets bentonite <br /> Depth to water �I 3y Bags sand/gravel :U01-Mix Ratios Filter Pack type/sizeInstallation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - ( n <br /> EH 29 29 ) <br /> Type of method <br />