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,%wONITORING WELL INSTALLATION REPG,,W <br /> Date: C��" CONSTRUCTION <br /> � b5 � <br /> Premise Address:-,a �►'� Total Depth 3 <br /> Screen Length (from) 3 C:) (to)___ <br /> Well No.:_ _ rn �J -7 Filter Pack (from) -2, c? (to) _ <br /> c . Bentonite (from) `b (to) <br /> Inspector: P Grout (from) (to) a <br /> 2 3 r o Drilling rig type - aA� <br /> Permit No. " 3 � Auger O.D. 0 I.D. '3 <br /> L� Completion - Stove pipe/ sue bo (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant G r G -� <br /> Geologist � <br /> AE;0V -GRCUND CiM*1Y-80X <br /> COMPLETION COMPL.EMN <br /> SPECIAL PERMIT INFO. Ground Sumacs �•�� <br /> Distance to sewer line Grout <br /> Domestic well on site - (y <br /> T ft. <br /> If yes, location and distan ft. <br /> f� ft. <br /> v » <br /> O <br /> SAMPLING 510 <br /> soden <br /> Holding Temperature = „w Pack <br /> Method -A,C1 ,vr\.- <br /> Screening Method rY'-\ — <br /> Tracking Sheet / n ) <br /> 36 <br /> SPOILS <br /> Storage Method ss — MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ) �r V C- <br /> Storage Location Casing type <br /> Blank L b ft. Screen 2"a ft. <br /> Slot size C)-)— <br /> GROLMNG Bags cement I .bo <br /> f l Buckets bentonite <br /> Depth to water 1 Bags sand/grave <br /> I <br /> Mix Ratios 6 0 Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ i <br /> Quantity Installed U13 Discussed with geologist: - (y On <br /> Type of method <br /> EH 29 29 <br />