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MONITORING WELL INSTALLATION REPO <br /> W. <br /> Premise Address: AW Cr CONSTRUCTION <br /> Well No.: �, �9 �S Total Depth ' <br /> n Screen Length (from) <br /> Inspector: �5tq Filter Pack (from) (to)— <br /> �— <br /> Bentonite (from)�(to) <br /> Permit No. 3Lr 3S Grout ---�(to) <br /> Drilling rig type <br /> Drilling Company: Auger O.D. <br /> Completion - Stove I'D' <br /> �, // pipe/christie box (circle Driller: iKtcG>r_C_ktw <br /> Consultant ILxc.. casin <br /> height <br /> Geologist <br /> AVE-GROUND <br /> SPECIAL PERMIT INFO. CONFLET;ON Cf R*-TY-BOX <br /> ? nd SLrf COMPLETION <br /> Distance to sewer line C A <br /> Domestic well on site - (y n grout <br /> If yes, location and distance Z <br /> - - a <br /> SAMPLING I = <br /> slonnd <br /> m <br /> Holding Teeature C +ac9on = S <br /> Method <br /> Screening Method <br /> Tracking Sheet - n ) q = <br /> SPOILS //-- . / �t <br /> Storage Method �^` za z ILQc�/ C MATERIALS/DEVELOPMENT <br /> Contamination Noted -[y'�n I <br /> / <br /> Storage LOCat]O.Z /*mac ��- Casing type I' �V <br /> Blank Sq fr. Screen / g fr, <br /> Slot size <br /> GROUTING Bags cement <br /> Depth to water = Buckets bentonite <br /> Bagssand/gravel <br /> Mix Rados <br /> Installation Method Filter Pack type/size Quantity Installed Surge Block: - (y n <br /> Discussed with geologist: - (y'U <br /> Type of method <br />