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%O'MONITORING WELL INSTALLATION REP.4c i <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth v <br /> Screen Length (from) 4o' (to)A s <br /> Well No.:–Mt.,- Filter Pack mom) !To _(to) M <br /> Bentonite (from)_-5-Q` _(to) SL ' <br /> Inspector: b (re rl"�� Grout (from). "3I, _(to) o' _ <br /> Drilling rig type <br /> Permit No. Auger O.D.^IL" I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:.- _��SL_.ti��G <br /> Driller-._ l7 _ casing <br /> height <br /> Consultant <br /> Geologist <br /> —Eqw—f <br /> ABOVE-GROUND <br /> CONFLETIGN CHRM Y43OX <br /> SPECIAL PERMIT INFO. Ground Siartacs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> :4r � <br /> V m <br /> *' b <br /> SAMPLING <br /> sac5on �� r <br /> Holding Temperature <br /> Method VIVO Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method i MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n ) <br /> Storage Location Casing type rr4 L Std k10'. <br /> Blank T ft. Screen <br /> Slot size_ D. at O <br /> GROUTING Bags cement N& _ <br /> Buckets bentonite_ C <br /> Depth to water ll.g Bags sand/gravel j (3 54 _ <br /> Mix Ratios Q Lk'*u> yo 1tA Filter Pack type/size <br /> Installation MethodSurge Block: - (y/n) <br /> Quantity Instalied_5$ ager _ Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 yN lk:E w��N <br /> (,� LLv�arlrv�- 5�� �r�,„t ..[I.�w•a.c�,� 5��- �Z�c <br />