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0 <br /> MONITORING WELL INSTALLATION REPOn i <br /> Date: �u�T �/_i OS 1 CONSTRUCTION 7 <br /> Premise Address✓ Total Depth /i S <br /> � Screen Length (from) (to) I C) <br /> Well No.: /56 — Filter Pack (from) !7 (to)� <br /> Bentonite (from) g (to) <br /> Inspector: Grout (from) (to) 2— <br /> q,,� Drilling rig type M 10 LC- <br /> Permit <br /> LPermit No. U/L C 3 d�° Auger O.D. Is I.D. <br /> Drilling Company: <br /> A � Completion - Stove pipe/christie box (circle one) <br /> - ( �J,,,� <br /> Driller:��1 `'''",/` C <br /> ca ing <br /> Consultant <br /> G td&ocL e ght <br /> GeologistN CHS BO <br /> N <br /> SPECIAL PERMIT INFO. [mond SuAxe <br /> Distance to sewer line � grout <br /> Domestic well on site - (y(D 1 s n <br /> If yes, location and distance - n <br /> = m <br /> — o <br /> - m <br /> — o <br /> SAMPLING cloned = <br /> tacdon <br /> Holding Temperature VaVq'Pack <br /> Method <br /> Screening Method ^'t' <br /> Tracking Sheet - ysn ) <br /> 25 <br /> SPOILS <br /> Storage Method i&L*Z J MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n ) l<< Q"k E� -? UC <br /> Storage Location Casing type /' <br /> Blank 11b ft. Screen <br /> Slot size D20 <br /> GROUTING Bags cement Z j— <br /> Buckets bentonite_ S <br /> Depth to water Bags sand/gravel 5 <br /> Mix Ratios J X Z Filter Pack type/size 3 <br /> Installation Method 9tw Surge Block: - (y <br /> Quantity Installed 30 Discussed with geo1 ogist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> .t <br /> q <br />