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4ONITORING WELL INSTALLATION REPOO <br /> Date: � CONSTRUCTION <br /> Premise Address: 7 �(i� Total Depth <br /> ! <br /> Screen Length (from) (to) rf <br /> Well No.: 'Ad Filter Pack (from) �y (to)�— <br /> Bentonite (from) (to) V--T <br /> Inspector: Grout (from) S T (to) .S <br /> Drilling rig type <br /> Permit No. 614—23 ,P` Auger O.D. & I.D. 3 <br /> �£ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> •� height <br /> l <br /> Consultant <br /> to <br /> e, <br /> Geologist <br /> ABOVE-GROUND CHAISTY480X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground S�'� <br /> ��A proof <br /> Distance to sewer line w <br /> Domestic well on site - (y/ n ) r S 5 tt• <br /> If yes, location and distance - <br /> _ m <br /> SAMPLING stoned .y <br /> Holding Temperature - Psi PacK <br /> Method = <br /> Screening Method = _ <br /> Tracking Sheet - (y/n) /0 <br /> tt tt. <br /> SPOILS n a <br /> Storage Method kid MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) /�r 2 I I /016CC <br /> Storage Location Casing type <br /> Blank �—f-5ft- Screen •S ft. <br /> Slot size <br /> GROUTING Bags cement <br /> t Buckets bentonite <br /> Depth to water �� Bags sand/gravel " <br /> Mix Ratios �{...h Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with gee ogist: - (y n ) <br /> Type of method <br /> EH 29 29 <br />