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- ` ti,.ONITORING WELL INSTALLATION REPO <br /> Date: -J 3 l CONSTRUCTION <br /> l <br /> Premise Address: � P _ Total Depth 3 <br /> Screen Length (from) :;0 (to) <br /> Well No.: y� w Filter Pack (from) a n (to) <br /> Bentonite (from) (to) <br /> Inspector. t�i . Grout (from) (to) e� <br /> Q Drilling rig type Q <br /> Permit No. f �S Auger O.D. V I.D. <br /> o� Completion - Stove pip stie box,(circle one) <br /> Drilling Company: Ci` <br /> Driller• casing <br /> Consultant <br /> 11 T height <br /> � Y <br /> Geologist cl _EWT <br /> A80VE-GACUNO CHR**Y-8Ox <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground 8u<faca <br /> Distance to sewer line 5 D / O(Out <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> v � <br /> SAMPLING tbttad <br /> 3 <br /> aoricn �• '— <br /> Holding Temperature " _ caval pack <br /> Method ..A.r n k <br /> Screening Method f YY\ <br /> Tracking Sheet n ) <br /> l� c� ft. JL <br /> SPOILS <br /> Storage Method S_5 G MATERIALS/DEVELOPMENT <br /> \f <br /> Contamination Note - y n) / r ' y <br /> Storage Location Casing type <br /> vr--- Blank l o ft- Screener ft. <br /> CL� 8Y'_ 'qv� Slot size 01- <br /> GROUTING Bags cemen 1. it�— <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios - Filter Pack type/size <br /> Installation Method Surge Block: - (y 10 <br /> Quantity InstalledDiscussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />