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MONITORING WELL INSTALLATION REPOk. <br /> Date: G CONSTRUCTION <br /> Premise Address: 2� O G Total Depth g <br /> n Screen Length (from) 1,V (to) 3 <br /> Well No.: Filter Pack (from)__%`i, (to) �s <br /> �- Bentonite (from) 9 (to) /.s <br /> Inspector: V Grout (from) (to) _ <br /> Drilling rig type <br /> Permit No. Auger O.D. D. <br /> �� Completio - ove pipe os circle one) <br /> Drilling Company: JA_, �dyL'r ` <br /> Driller: f r� casing <br /> height <br /> Consultant C <br /> n .7 _VVT <br /> PTAe <br /> Geologist G _ -- <br /> ABOVE-GROUND CKRtm-BOX <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. (around Suriacs <br /> Distance to sewer liner//. grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> Zk <br /> m <br /> r <br /> C <br /> SAMPLING glornd <br /> .8 <br /> aacticn - <br /> Holding Temperature = gr,Yol Pack <br /> Method S'Q A <br /> Screening Method " _= <br /> Tracking Sheet <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) / <br /> Storage Location Casing type SL°L1 (ID JZ' <br /> Blank — ' ft. Screen <br /> Slot size nZ Z <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type si <br /> Installation Method 1` �// Surge Block: - ii <br /> Quantity Installed Discussed with ge ogist: - y n ) <br /> Type of method <br /> EH 29 29 <br />