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„ .,JNITORING WELL INSTALLATION REPO <br /> Date: IO CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 3 0 (to) 16 <br /> Well No.: Filter Pack (from) 3'O (toT--�— <br /> Bentonite (from) R (to) -G <br /> Inspector: Grout (from) 5 (to) O <br /> Drilling rig type C,M P-:;' 45 <br /> Permit No. Auger O.D.Io`!z_ I.D. S sT <br /> 1,h Completion -Stove pip ensue box circle one) <br /> Drilling Company: Yy�.L <br /> �h�- f��ll a �Gti✓�I l�- <br /> Driller: Fobs� Mav -7-tyy - {.e t;tr,, casing <br /> 1 T height <br /> Consultant ��-✓L � ���.c.J�2� <br /> N� �. <br /> Geologist <br /> Hvld ABOVE-GROUND CHRISTY-aoX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line �f10"t <br /> Domestic well on site - (y/ <br /> If yes, location and distance 20 ft. <br /> ; ..ft. _ <br /> = a <br /> SAMPLING slotted <br /> aacicn — <br /> Holding Temperature = „�pack <br /> Method I U w/ KO <br /> a y, — <br /> Screening Method T1x�> — <br /> Tracking Sheet n ) Qb( tv. :?F .4. <br /> s �_tt. _._. fL <br /> 3�w c�.✓.a�.E sl5 <br /> SPOILS <br /> Storage Method h MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n �� \1CStorage Location_ Casing type `1 <br /> Blank----4P—ft. Screen 20 ft. <br /> Slot size O 2b <br /> GROUTING Bags cement <br /> Buckets bentoniteL:2e 1e <br /> Depth to water SCI Bags sand/gravel <br /> Mix Ratios Filter Pack type/ ' e <br /> Installation Method +ye-e.- t*r - Surge Block: - ' n ) <br /> Quantity Installed ---” a-Q� vJ Kut 6 Wfil1 Discussed with geologist: -�� n <br /> Type of method— �4 <br /> EH 29 29 <br /> \kt 4-v() <br />