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('�W,JNITORING WELL INSTALLATION REPCj <br /> Date: I 1 CONSTRUCTION <br /> Premise Address: o�(�Sf S- c (,(/y� Total Depth S <br /> M <br /> 1 W1 1 a v Screen Length (from) 7y _(to) .'3 Lt <br /> Well No.: I � � 0 Filter Pack (from) 74 /z, (to) -S I <br /> Bentonite (from) 31 (to) <br /> Inspector Grout I (from) (to) <br /> O 63 a ?i Drilling rig type <br /> Pennit.No. Auger O.D. ib ff I.D. <br /> Drilling Company:_ <br /> S L Completion-Stove pipe/l!!! <br /> z circle one) <br /> Driller. T oaslnq <br /> height <br /> Consultant T <br /> Geologist T <br /> ABOVE-GACUND C1WtSTY80X <br /> OOMPLEPION COMPLETION <br /> SPECIAL PERMIT INFO, o..�Cira+nd Surface <br /> Distance to sewer line �0m <br /> Domestic well on site - (yn <br /> If yes, location and distance3I`( & <br /> n. <br /> = s <br /> SAMPLING <br /> eeeden <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet fyy n <br /> ti .. _ LV21t <br /> SPOILS <br /> Storage Method _ ___ - MATF.RIALS/DEVELOPMENT <br /> Contamination Noted • / <br /> Storage Location U y Casing type <br /> Blank ft. Screen ft <br /> Slot size I_ <br /> GROUTING Bags cement <br /> ( Buckets bentonite <br /> Depth to water, _- S ____ __—._ Bags sand/gravel _ <br /> Mix Ratios _ Filter Pack type/size Pm a y <br /> Installation Methods _ - - Surge Block: - (y ) <br /> Quantity Installed _ _ Discussed with g alogist: - (y/ n <br /> / Type of method - <br /> EH 29 29 (9� � <br />