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MONITORING WELL INSTALLATION REPOr,,f <br /> Date: -0-0 '�/ / CONSTRUCTION <br /> Premise Address: 2!i JV. UV G►'/�1l Total Depth 7d <br /> Screen Length (from) d (to) / <br /> Well No.: � Filter Pack (from) (to) <br /> Bentonite (from) (to)� <br /> Inspector: Grout (from) (to) a <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> 51 <br /> Completion - Stove pip Christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> / height <br /> Consultant <br /> Geologist /i �mze- <br /> ABOVE-GROUND <br /> COMPLETCN Iii <br /> C <br /> SPECIAL PERMIT INFO. Ground Surf acs <br /> Distance to sewer line grout <br /> Domestic well on site y n ) /39. j If yes, location and distance - ft' <br /> �ft ft. <br /> I F <br /> SAMPLING ./) <br /> Holding Temperature = <br /> Method = P <br /> ack <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method Fa4<0-0 V_� MATERIALS/REVELOPMENT <br /> Contamination Noto,- n ) cl <br /> Storage Location Casing type 2, c 111-Y" <br /> Blank ft. Screen-----1.9­—ft- <br /> Slot <br /> creen_-19ft.Slot size OZU <br /> GROUTING Bags cement -- -c <br /> Buckets bentonite J <br /> Depth to water �S Bags sand/gravel <br /> Mix Ratios - 30 �`" Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed r Discussed with geologist: - (yn <br /> Type of method <br /> EH 29 29 <br />