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10 <br /> ivIONITORING WELL INSTALLATION REPOrii <br /> Date: \ 3 E �, Ld 1 d CONSTRUCTION <br /> Premise Address: GG'LO — Total Depth J <br /> Screen Length (from) (to) <br /> Well No.: AC Filter Pack (from) (to) I <br /> Bentonite (from) (to)�� <br /> Inspector: Grout (from) (to) f__ <br /> Q�p Q 0 6 y Drilling rig type / <br /> Permit No. / Auger O.D. I.D. <br /> f Co St ve pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: /4" casi g <br /> heigh <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND Ct6ilSTY-BOX <br /> COMPLETbN COMPLETION <br /> SPECIAL PERMIT INFO. nd Surface <br /> Distance to sewer line <br /> N� orate <br /> Domestic well on site - ( y 0 n <br /> If yes, location and distance - <br /> n. <br /> n. <br /> n <br /> = m <br /> SAMPLING dottad = c <br /> sactan — - <br /> Holding Temperature= P <br /> Method = <br /> aCK <br /> Screening Method_ <br /> Tracking Sheet - ( y/ n ) _. <br /> n. n. <br /> SPOILS <br /> Storage Method �Ly _ MATERIALS/DEVELOPMENT <br /> Contamination No ed - ( y A:j) <br /> Storage Locatior_ Casing type <br /> Blank ft. Screen _fr. <br /> Slot size -n .10 <br /> GROUTING Bags cement__ <br /> 7 f 7 Buckets bentonite hboa, <br /> Depth to water ,° I Bags sand/gravel O+ _ <br /> Mix Ratios tQa Filter Pack type/sizey <br /> Installation Megod e K _ Surge B:ock: - (y n <br /> Quantity InstalledDiscussed with geologist: - (y/0 <br /> ) <br /> Type of method <br /> EH 29 29 <br />