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MOMTORING WE=INSTALLATION REPORT <br /> Date: //, % '�� _— CONS'IRUC ON <br /> premise Address: 3Y 3 7 Toral Depth <br /> S -1 <br /> Screen Length (from) ` � (to) <br /> Well No-: Frlter Pack (from) (to) 7i <br /> Bentonite (from) 7/ (to) <br /> Inspector: . ; Grout (from) (to) Cry <br /> Dulling rig type �r'c< • 4, <br /> Permit No.No. Auger O.D. (o jly I.D. <br /> Completion- Stove pipe/chrsrie box (crcie one) <br /> DrMing Company. .44 <br /> _ casing <br /> o mac/ --- <br /> he_49hz <br /> Consultant <br /> Geologist <br /> ABOVS-GROUND <br /> SPECIAL P^RNIIT INFC. Gczrnd Sirha , <br /> proc.: <br /> Distance to sewer line I <br /> Domestic well on site - C y <br /> if yes, location and distance <br /> 0 <br /> SAMPTUNG <br /> u � <br /> Holding Tempe_ature - vmvw <br /> Method ~: <br /> Screening Method _ Li.:' <br /> Tracking Sheet <br /> » ♦ � 3 r.. <br /> SPOILS <br /> Storage Method IvMA-I_--RIALS/D T OPNE2\T,' <br /> Contamination Noted - (y <br /> Storage Location Casing type ���4– GL <br /> Blank ft. Screen /a ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water L/ Bags sand/gravel <br /> Mix Ratios i-,���O�n� alter Pack type/size <br /> h.1ir, Surge 3locic - ( / n ) <br /> Installarion Method - St.c.�e/y w c <br /> Quantity Insmlled ' Discussed with geologsa - n ) <br /> Type of method <br /> H2929 <br />