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MONITORING WELL INSTALLATION REPOr�f <br /> Date: 3 f LAS CONSTRUCTION <br /> Premise Address: 20(0 ZI "4, Total Depth J <br /> / Screen Length (from) Z50 (to) <br /> Well No.: /� (� Filter Pack (from) (to) L <br /> Bentonite �j (from) Z (to) <br /> Inspector: Grout—U-0-- , (from) (to) <br /> ^�, Drilling rig type <br /> Permit No. -5XDd �/ 7-ZV Auger O.D. I.D. <br /> �+ w Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: " <br /> Driller:—0ay `"'l e �Q^+ " casing -- <br /> height <br /> Consultant <br /> Geologist >� C ._ T <br /> ABOVE-GROUND <br /> C�MPL.ETION C4-!Rl.STY-80X <br /> COMPL_ET1CN <br /> SPECIAL PERMIT INFO. Ground SLztacs <br /> Distance to sewer line �� Rzl <br /> Qf0`t <br /> Domestic well on site - On ) <br /> If yes, location and distance - 1 <br /> LLQ ft. � <br /> = a <br /> O <br /> C <br /> O <br /> SAMPLING t�ottad = <br /> Holding Temperature <br /> VivW <br /> Method = F <br /> ack <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) ' <br /> SPOILS SSS �o <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type X� V <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING „Bags <br /> Buckets bentonite <br /> Depth to water -- 451 Bags sand/gravel <br /> Mix Ratios ' f Filter Pack type/size 3 <br /> Installation Method d Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />