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' .MONITORING WELL INSTALLATION REOr <br /> s <br /> Date:_ I t I0�7 <br /> CON_ STRUCTION <br /> Premise Address:CI.L (A 1 `fie 2P <br /> Total Depth <br /> Well No.;_ ]W k ) std Screen Length <br /> Filter Pack (from —(to) — <br /> inspector. ( �( >^ Bentonite (from) <br /> Grout (from)`_(to)- -4 � <br /> _ <br /> Permit No. / Drilling rig type <br /> -r2 (to) <br /> �I � 1 Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle <br /> DrillerA <br /> . LA <br /> casing <br /> Consultant 6per..-,y height <br /> Geologist CL �_ 1.4si <br /> � -rr- <br /> ABCVEGRCOND ^ <br /> SPECIAL PERMIT INFO. CCf. LEMN C4-RZTY-8OX <br /> G=rd � <br /> Distance to server line • <br /> Domestic well on - (y/n) grout <br /> If yes, loca ' and distance - <br /> 2 5 ft. <br /> SANG <br /> .form = c <br /> Holding Temperature mn t �� soden = S <br /> Method <br /> Screening Method - _ gRvalwdt <br /> Tracking Sheet - <br /> (y/n ) _ .. <br /> SPOILS — 1t• - = tt <br /> Storage Method rs <br /> Contamination Noted • MATERIAIS/DEVE[i Opp <br /> Storage Locati ( p <br /> Q CasingBlank type ' <br /> ft Screen---S-7-7 <br /> GROUTING UTING Slot size oZd <br /> Bags cement <br /> Depth to water N Z 'S l Buckets bentonite <br /> Mix Ratios _ Bags sand/gravcl_ v] <br /> Installation Metho re Filter Pack type/size z Zg <br /> Quantity Installed cw ,. - Surge Block. - (y//�) <br /> Discussed with geo gist: - (y/ <br /> EH 29 29 Type of method <br /> �011llb �i S � Mbtl- 2 <br />