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MONITORING WELL INSTALLATION REPOn f <br /> Date: 'T ' �� " Q CONSTRUCTION <br /> Premise Address: X07 2L/l Al Gf/�(./GGf Total Depth 07 <br /> Screen Length (from) (to) <br /> Well No.- Filter Pack (from) (to) X3.5 <br /> Bentonite (from) 7-2-5 (to) 7/. <br /> Inspector: Grout (from) 7/- 5 (to) <br /> Drilling rig type G ctic�� <br /> Permit No. 33 Auger O.D. 91 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ����� <br /> Driller: casing <br /> height <br /> Consultant A D� <br /> Geologist <br /> ABOVE.GR0Ut4D CNAISrY-BOX <br /> COWPLETION Pt-ETI <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) 7 •� ' ft. <br /> If yes, location and distance - 3. 5 ft. <br /> ft. <br /> SAMPLING slotted <br /> 7 sedan <br /> Holding Temperature Sr'raye,Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method LOX E GU MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n) �" PI)e- _ 9dA_ ¢o <br /> Storage Location 01 �j le'l Casing type <br /> Blank ft. Screen M ft• <br /> Slot size_ - <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - �y ' n) <br /> Quantity Installed Discussed with geologist: (y/ n) <br /> Type of method <br /> EH 29 29 <br />