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Ground SLrf act <br />grout <br />' ft. <br />ft. <br />ft <br />I <br />casing <br />-F. height <br />ABOVE-GROUND <br />001v1PLETION C4-STY-BOX • <br />COMPLETION <br />11 <br />MONITORING WELL INSTALLATION REPO.. <br />Date: <br />Premise Address: tit-0 <br />Well No.: No.: KA-eV-La/YU, <br />Inspector: <br />Permit No. <br />Drilling Company: iTalk <br />Driller: <br />Consultant A(...a'z-- <br />Geologist ( C <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted- ( y / n) <br />Storage Location <br />GROUTING <br />Depth to wate <br /> <br />2- <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank ft. Screen ft. <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block:- ( y / n) <br />Discussed with geologist: - ( y / n) <br />Type of method <br />/ <br />EH 29 29 <br />CONSTRUCTION <br />Total Depth 90' 11) (06 <br />Screen Length (from) (to) <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Grout (from) (to) <br />Drilling rig type <br />Auger OD. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />tutO