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,2NITORING WELL INSTALLATION REPOk ` <br /> i <br /> i <br /> Date; L $ CONSTRUCTION <br /> 64� <br /> JZ� <br /> Premise Address:& A Me Total Depth s/5 <br /> aj Screen Length (from) i (to) 3/ <br /> Well No.: ' l Filter Pack (from) 5W -(to)� ` <br /> Bentonite (from) (to) (0- 16 <br /> Inspector: Grout (from) _ Z% G (to) <br /> Drilling rig type --7-0 <br /> Permit No. 05 7,73 Ovm,__� Auger O.D. I.D. <br /> CompletionStove pipe%christie box (circle one) <br /> Drilling Company: �� r�•„ <br /> Driller: /'lam-G_ t cas' ng <br /> $ <br /> IN- height: <br /> Consultant <br /> Geologist- - _ •� <br /> r+-^ ABOVE-GROUND C#-ERs,STY-BOX <br /> .� - ► COMPLETION t , <br /> SPECIAL PERMIT.INFO. N1— .. ., ,� Gcmmrd SuncCa <br /> Distance'i6'a',sewer line �» ? 1 ;t Qt°"t <br /> Domesticweli on site , • 2(p•� <br /> If yes, location and distance - - - <br /> *+ �' f/ ft. <br /> a'd <br /> �� m <br /> ID <br /> � SAMPLING =' Y slatted = c <br /> an <br /> Holding Temperature <br /> ` Method <br /> Screening Method <br /> Tracking Sheet_-([D� n ) <br /> SPOILS <br /> Storage Method <br /> ✓S • MATERIALS/DEVEi OPiVIENT <br /> �� � - , <br /> Contamination Not (y I -'w ..S0 <br /> Storage Location- Casing type <br /> '� ► Blank _ c'31 &- ~`.Screen 20 ft. <br /> Slot size' ' "EnD <br /> GROUTING :..� µ _.Bags.cement " <br /> Buckets bentonite 0- 5 <br /> Depth to water Z+ Bags,sand/graveI M <br /> Mix Ratios l� -f- 35 Filter Pack type/sii <br /> ze • t <br /> Installation Method Surge Block: - (y n <br /> Quantity.Installed g I Discussed with geo ogist: - ©n ) <br /> ' Type of method <br /> y �8' � s•I�s Cis <br />