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l <br /> NITORING WELL INSTALLATION REP <br /> Date: CONSTRUCTION _ <br /> Premise Address:.. AAA_ Total Depth <br /> A ` Screen Length (from) (to) <br /> Well No.: ___""ir_ Filter Pack (from) (to) 4 <br /> Bentonite (from) 4/ (to) 3$ <br /> Inspector. g. Grout (from). �Sa to -6— <br /> Drilling rig type 55 <br /> Permit No, Auger O.D. R-ZSr I.D. z� i <br /> Completion - Stove pip stie bo (circle one) i <br /> Drilling Company:,�1d�LC <br /> Driller: �1 ) casIng i <br /> height <br /> i <br /> Consultant G �- <br /> r I <br /> Geologist c �G eeTK rv�c-K r y <br /> ABOVE-GRCVND CiiMST 4= <br /> COMPLETION COMPLEIZON <br /> SPECIAL PERMIT INFO. s Ground surface ' <br /> Distance to sewer line r grout <br /> Domestic well on site - (y/ n) r �ft. <br /> If yes, location and distance - fL <br /> - — dp i <br /> SAMPLING =lotted — <br /> Holding Temperature 4Q, <br /> Method /fes — pal <br /> - ;: _ <br /> Screening Method _ <br /> Tracking Sheet - (y/n ) ' _ <br /> t n. �« .M M <br /> SPOILS <br /> Storage Method_ !z*T MATERIALS/DEVELOPMENT <br /> k <br /> Contamination Noted - (y/n ) 1t <br /> Storage Locationming type <br /> Blank ft. Screen ft. <br /> Slot size 4• C� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags?J Bags sand/gmvel 5 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geo 4st: - n ) <br /> Type of method <br /> EH 29 29 I <br />