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i ONITORING WELL INSTALLATION REPO T <br /> Date: /2: 'r�o p0 CONSTRUCTION <br /> YC.2 �I.CQCA / <br /> Premise Address: /T G 1 / Total Depth r , <br /> Screen Length (from) (to) <br /> Well No.: �" Filter Pack (from) 75 (to) <br /> Bentonite (from) (to) SL <br /> Inspector: Grout (from) 7L (to) •{-3 <br /> / Drilling rig type 700 <br /> Permit No. Auger O.D. ?' I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: G��XR �t/LCu%^�lw� rGrmourid <br /> Consultant <br /> Geologist <br /> CHA157Y BO% <br /> COMPLETION <br /> SPECIAL PERMIT INFO. n <br /> Distance to sewer line /bD0Omit <br /> Domestic well on site - y n) <br /> If yes, location and distance - <br /> A <br /> t <br /> C <br /> SAMPLING slotted _ �' <br /> 7 accdan = ' <br /> Holding Temperature = gravol pack <br /> Method <br /> Screening Method = `. <br /> Tracking Sheet - (y/n ) _ N <br /> ft. <br /> SPOILS S <br /> Storage Method -e MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) �0 ,/�y <br /> Storage Location Casing type !� <br /> Blank S ft. Screen / ft. <br /> Slot size , O ZO <br /> GROUTING Bags cement <br /> ? Buckets bentonite Z /r•c-s —" <br /> Depth to water ? S Bags sand/gravel <br /> Mix Ratios -r Filter Pack type/size <br /> Installation Method Surge Block: - (y <br /> Quantity Installed � Discussed with geo-o-gist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />