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MONITORING WELL INSTALLATION REPOn.f <br /> Date: Z 3/os CONSTRUCTION <br /> Premise Address: �`� Total Depth /oo <br /> Screen Length (from) /�� (to) �y <br /> Well No.: Filter Pack (from) _(to) P.F <br /> Bentonite <br /> Inspector: Grout (from) 8 (to) d <br /> Drilling rig type Gtu-G ' 75� <br /> Permit No. Auger O.D. I <br /> I, Completion - Stove pi Christie box cle one) <br /> Drilling Company: <br /> Driller: f � c,� casing <br /> j height <br /> Consultant ��`��`� <br /> Geologist <br /> ABOVE-GROUND <br /> 0C N9 LETO N C-S STY-BO X <br /> ccMtpt <br /> SPECIAL PERMIT INFO. Ground Suiac4 <br /> Distance to sewer line grout <br /> Domestic well on site - y n ) <br /> If yes, location and distance - <br /> _ a <br /> = m <br /> _ o <br /> = m <br /> SAMPLING dotted <br /> Holding Temperature No <br /> Method = <br /> Screening Method V = <br /> Tracking Sheet - ( y/ n ) _ <br /> A� n• <br /> SPOILS <br /> Storage Method (rh E V MATERIALS/E;EVELOPMENT <br /> Contamination Noted - ( y/ n ) z i� <br /> Storage Location S Casing type <br /> Blank 0D ft. Screen Iy R <br /> Slot size . 0?•O <br /> GROUTING Bags cement <br /> // Buckets bentonite <br /> Depth to water 10d Bags sand/gravel <br /> Mix Ratios Filter Pack type,Is <br /> 3 <br /> Installation M od Surge Block: - (y n <br /> Quantity Installed 2-0 64-p .e c Discussed with geologist: - (y/0 <br /> Type of method <br /> EH 29 29 <br /> 6 12j'316 5 %� <br />