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MONITORING WELL INSTALLATION REPO <br /> Dare: 3 g5 7 CONSTRUCTION <br /> Premise Address: r OfTotal Depth <br /> / Screen Length (from) r (to) <br /> Well No,._ d4 4 �/y Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. vP� Grout (from� �(to) <br /> Drilling rig typed%� <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:�i�o�� <br /> Driller: casing <br /> height <br /> Consultant V <br /> Geologist -- <br /> ABOVE-GRCUNDN r <br /> C7�tISTY 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sulaa <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y/ n ) It. <br /> If yes, location and distance - <br /> ft ft. <br /> v _ n <br /> 0 <br /> SAMPLING <br /> soden = <br /> Holding Temperature = VW Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. V = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) 2, ' <br /> 7 I <br /> Storage Location Casing type 2 <br /> Blank ft. Screen___: ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 7 Bags sand/gravel <br /> Mix Ratios Filter Pack type/ 'ze <br /> Installation Method_ >tP,tn, , Surge Block: - /c�" <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />