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MONITORING WELL INSTALLATION REP(.,,,i' <br /> Date: T' / " Z CONSTRUCTION <br /> Premise Address: �6 ?i// /fj- GVC� / Total Depth �d ' <br /> Screen Length (from) (to) <br /> Well No.: 24W 0p Filter Pack (from) (to) <br /> Bentonite (from) (to) �o <br /> Inspector: Grout (from) (to) <br /> Drilling rig type a"d'� <br /> Permit No. 6 en2 9':3 l Auger O.D. I.D. <br /> /y Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> �j height . <br /> Consultant lC( G E <br /> Geologist -3LL U 7� •- <br /> ABOVE-GROUND fST Y-80X <br /> CONFLETION C <br /> ON <br /> SPECIAL PERMIT INFO. Ground Surfwe <br /> Distance to sewer line ? grout <br /> Domestic well on site - (y 3�p <br /> If yes, location and distance - 3F <br /> ft. <br /> ft. <br /> O <br /> C <br /> O <br /> SAMPLING sloitad = c <br /> Holding Temperature _ YSI pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> tt. = ft. <br /> SPOILS LU <br /> Storage Method -f 9 MATERIALS/DEVELOPMENT <br /> Contamination Noted • y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ZU ft. <br /> Slot size ZD <br /> GROUTING Bags cement <br /> Buckets bentonite l <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y 40 � <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 ' <br />