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MONITORING WELL INSTALLATION REPOiZT <br /> , <br /> Date: 3-9-046 CONSTRUCTION <br /> Premise Address: /9,C � � /V� wG� (//' lZ <br /> Q`f Total Depth <br /> �y O Screen Length (from) z (to) YZ <br /> Well No.: !�l� Filter Pack (from) t (to) 2 <br /> Bentonite (from) 42 2 (to) .5 ' <br /> Inspector: Grout (from) Z- (to) <br /> � Drilling rig type <br /> Permit No. LOD l Auger O.D. $ I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> (��l <br /> Driller: * vim( casing <br /> Lam`/ � height <br /> Consultant j�� <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CNAISTY-BOX <br /> SPECIAL PERMIT INFO. Ground Suriac9 <br /> Distance to sewer line grout <br /> Domestic well on site - ( yam <br /> If yes, location and distance - <br /> L n, <br /> SAMPLING _ <br /> c <br /> slottad — <br /> �yo n socton _ <br /> Holding Temp <br /> Method 9 vi pack <br /> Screening Method <br /> Tracking Sheet - ( y n ) <br /> SPOILS <br /> Storage Method �JG MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location Casing type 2 QU 40 <br /> Blank ft. Screen ZO ft. <br /> Slot size . 02.0 <br /> GROUTING Bags cement '= <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size Z112- <br /> Installation <br /> IZInstallation Method Surge Block: - ( y/ n ) <br /> Quantity Installedw.._ Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 34- <br />