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NITORING WELL INSTALLATION REPOT <br /> Date:_ ///���1 J CONSTRUCTION <br /> Premise Address: 3a �-ryS• h��'`�c�?2 1rval . Total Depth <br /> , D„ ��0 i Screen Length (from) (to) <br /> Well No.: �QD J` "�J Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. (O!� Auger O.D. I.D. <br /> Q Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ <br /> Driller: �( casing <br /> J height= <br /> Consultant <br /> Geologist .^ �► <br /> A80VE-GRCUND <br /> CO NFLETC N CHRZT Y-80X <br /> SPECIAL PERMIT INFO GCOMPLETICN <br /> Ground Sirfa�ca <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> � ft. <br /> C <br /> SAMPLING — a <br /> eloC.ad :.f = c <br /> C�D aocicn — <br /> Holding Tempera e L <br /> Method �r;- — �rave�pack <br /> .: <br /> ., <br /> Screening _— <br /> Tracking Sheet - ( y n ) <br /> eft. ft. <br /> SPOILS <br /> Storage Method N MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> N (� 0 ��� Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios----- Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />