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ACINITORING WELL INSTALLATION REPS._.f <br /> Date: P_13 I o O CONSTRUCTION <br /> Premise Address:__aO R fl�.fAA -6CA Total Depth <br /> Screen Length (from) Cc (to) T <br /> Well No.: et-)1A © Filter Pack (from) (to) <br /> Bentonite (from) -(to)- <br /> Inspector: L, Grout (from) (to) �( <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> '��,� Completion - Stove pipe/chris[ie box (circle one) <br /> Drilling Company:W e,_4 .��Q V <br /> Driller. casing <br /> he=ght <br /> Consultant e,ccS1 '9'GeologistABOVE-GACUND L- 1 <br /> 00NVLETCN SPECIAL PERMIT INFO. Ground Sum <br /> Distance to sewer line Grcut <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and dist e - ft. <br /> SAMPLING a(orai <br /> :oc'icn — <br /> 8 <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Shcet y/ n ) — <br /> T ft. V <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted L (y/n <br /> Storage LocationoAn Casing type L1 Qy L <br /> Blank . 5 ft. Screen a0 ft. <br /> Slot size • o i o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -VP 3 <br /> Installation Method Surge Block: - ( y/(/n',1 <br /> Quantity Installed Discussed with geo st: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />