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ONITORING WELL INSTALLATION REPOY.i, <br /> Date: E 1'1 'b CONSTRUCTION <br /> Premise Address-O 0 `� Total Depth <br /> Screen Length (from) [to} <br /> Well No.: U"' [� Filter Pack (from)_�_(to) <br /> Bentonite (from) (to} <br /> Inspector: Grout Grout (fro (to) <br /> Drilling rig type <br /> Permit No- P M N Auger O.D. 0: e( I.D. 1L <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant AG T <br /> Geologist •- <br /> ABOVEr-GROUND CKRtM4= <br /> COWFLET10N GOMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surfsct <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - • <br /> >. <br /> O <br /> SAMPLING <br /> Holding Temperature 7gmvsl packMethod LSR 7 1�jz ` _— <br /> Screening Method ,� = — <br /> Tracking Sheet - (y/ n ) k <br /> c; <br /> SPOILS <br /> Storage Method�'c C", S MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n ) <br /> Storage Location Casing e �„ <br /> Blank ft. Screen J, 0ft. <br /> Slot size 0 n- <br /> GROUTING Bags cement - <br /> Buckets bentonite XM - <br /> Depth to water , Bags sand/gravel <br /> Mix Ratios"-� Filter Pack type/s' e <br /> Installation Method Surge BIock: - ( n ) <br /> Quantity Installed 4 E 3 Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />