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ABOVE-GRCUND C.-STY-OX • <br />CONPLETION COMPL_T1CN <br />Grcuncl Sin ace <br />grout <br />casing <br />height <br />NIF <br />MONITORING WELL INSTALLATION REPORT <br />VI <br />37z_ i/(1,--71/--(, P-4 <br />inspecor: <br />Permit No. <br />Drilling Company: (4. <br />Driller: ( <br />Consultant AG(' <br />Geologist 017'6 <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site- ( y / n) <br />If ye; location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method_2/2)_---_ <br />Tracking Sheet - ( y / n) <br />SPOILS <br />Storage Method <br />Contamination Noted • ( y / n) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />EH 29 29 <br />CONSTRUCTION <br />Total Depth 50 <br />Screen Length (from) sr, (to) 670 <br />Filter Pack (from) 73O (to) <br />Grout (fro C-6( (to) <br />(to)7;,..._ Bentonite (from) SS' <br />Drilling rig type /pi- — '75-- <br />Auger OD. / 0 f/L4 4 ID. g <br />Completion - Stove pipe/christie box (circle one) <br />MATERIALS/DEVELOPMENT <br />p tic/ Casing type <br />Blank c4 <br />Slot size . eze) <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( / n) <br />Discussed with geologist: -(Tj?/ n) <br />Type of method <br />Date: <br />Premise Address: <br />Well No.: <br />0C/ <br />ft.