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`^MONITORING WELL INSTALLATION REPe9KT <br /> i <br /> Date: <br /> U3 CONSTRUCTION <br /> Premise Address: �� S W+ u" L_ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: <br /> rhW Filter Pack (from) ' (to) c� <br /> Bentonite (from) -:51 (to) 3 3 <br /> Inspector: C Grout (from) 7/ (to) / <br /> Drilling rig type r c- <br /> Permit No. �� 32� Z D Auger O.D. I.D. <br /> V� w Completion - Stove pipe/christie box (circle one) <br /> Drilling CompanCJy: <br /> Driller: '/�� casing <br /> height <br /> I <br /> Consultant �'"�J�—`'" ��� <br /> Geologist <br /> ABOVE-GROUND CHAISTY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground 6uAaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) tt <br /> If yes, location and distance - tt <br /> tt. <br /> e <br /> c <br /> o <br /> SAMPLING slotted <br /> sac5on —_ <br /> Holding Temperature = gmvel Pack <br /> Method =_ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> tt. = IFtt <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank �S 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 <br /> Installation Method Surge Block: - ((} / n ) <br /> Quantity Installed Discussed with geologist: - (d�/ n) <br /> EH 29 29 <br /> Type of method <br /> � iv �(� ��u' <br /> 9 bud c <br />