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V)NITORING WELL INSTALLATION REPOv <br /> Date: CONSTRUCTION <br /> Premise Address: <br /> � Total Depth 001 <br /> Screen Length (from) (to) 1 U0 <br /> Well No.: (Y\ Filter Pack (from) (to} <br /> Bentonite (from) (to): <br /> Inspector: Grout (fro ) (to) Bd <br /> Drilling rig type .nAa _ <br /> Permit No. — s S Auger O.D. T" I-D. <br /> Completion - Stove pipe/cluis[ie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologis ArABOVE-GRCOND <br /> COMPLETION CNA1SiY-80X <br /> SPECIAL PERMIT INFO. Ground Surfaces + <br /> Distance to <br /> 10 D grout <br /> Domestic well on site - y n) -3 D <br /> If yes, location and dist e - � / � �it• ft- <br /> O <br /> SAMPLING sbroi <br /> 3 <br /> sodcn �• <br /> Holding TeAiperature ." = <br /> pack <br /> Method fir; <br /> Screening Method L J2 <br /> Tracking Sheet - (y/ n ) <br /> tL <br /> SPOILS pp �,— <br /> Storage Method_ MATERIALS/DEVEI.OPMENT <br /> Contamination Not6d - (y%n ) nuD o&-- Pt �./� `°�' f V C <br /> Storage Location o Casing type <br /> Blank ft. Screen ft. <br /> Slot size y <br /> GROUTING Bags cement f <br /> / Buckets bentonite <br /> Depth to water 3 Bags sand/graveI <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y i —3 <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />