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(,�NITORING WELL.INSTALLATION REPC'I <br /> Date: CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> —_ Screen Length (from) 46& (to) .6 <br /> Well No.: Filter Pack (from) Ito 6 (to) 1 <br /> m . Bentonite �. (from) (to) 41 I _ <br /> Inspector: . Grout 1 (from) t (to) <br /> Drillirig rig type 1 <br /> Permit No. Auger;'O.D. <br /> completion -;Stove pipe/christie box (circle one) <br /> Drilling Company:_ _ <br /> Driller.. casinq <br /> height <br /> Consultant �9� r�77� <br /> '4 <br /> Geologist �A <br /> ABOVE-GROUNDp.M=S�Y-8CX <br /> C0MPLFrXDN COMPI.�mCN <br /> SPECIAL PERMIT INFO. i3 r C=nd Sci fwe <br /> Distance to sewer line �J <br /> Domestic well on site - (y/ 41 ft. <br /> If yes, location and distance - �.r li ft.`tTP........_.R. 3 <br /> v _ a <br /> SAMPLING sbr.4.i <br /> s cn <br /> Holding Temperature V <br /> Method V <br /> Screening Method <br /> .T. <br /> Tracking Sheet - (y/ n) i <br /> ft <br /> SPOILS a _ #. <br /> Storage Method Ste- RIALS/DEVELOPMENT <br /> Contamination Noted a(y2/ �. <br /> Storage LocationCasing type AUG l <br /> Blank::: it. Screen 2.0 ft. <br /> r Slot size b <br /> GROUTING s Bags dements I a (174110) <br /> _ c.rpar Buckets bentonite I <br /> Depth to water Sags sand/gravel 1 <br /> Mix Ratios_5 g4 a 9a(V-F0Irt go 4,a _i L55�cQ Filter Pack type/siz ' <br /> Installation Method 15' e ' � Surge,Block: - ( / n f� j <br /> Quantity Installed 1 Discussed with geo ogist: - (y-,� n) <br /> Type of method <br /> EH 29 29 . . . . k <br /> �bcz' <br /> it i <br />