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r, ONITORING WELL INST TION REPOnt-`� <br /> Date: / �Q s CONSTRUCTION <br /> /+ 9 / <br /> Premise Address: Z3;0 fl 23�s Total Depth <br /> Screen Length (from) (to) <br /> Well No.: l0, Filter Pack (from) (to) 6 <br /> Bentonite (from) /6-7-4 <br /> (to) <br /> Inspector:. Grout (from) 5 (to) O <br /> Drilling rig type c4u- <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/Christie box (circle one) <br /> Drilling Company: <br /> Driller: A / tt � casing <br /> height <br /> Consultant L�- <br /> Geologist / �" 7 <br /> ABOVE-GROUND <br /> -` �COMPLETION __ C�IAZIry-Bax . <br /> COMPLETIC <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to­sewer line grout <br /> Domestic wit'UnI site - n( y If yes, location <br /> and distance - ft. <br /> SAMPLING " - t =lotted = c <br /> Holding Tem'era T — IMS Pa <br /> Method,__ i `M <br /> k Screening Method- x /V014-1� <br /> ;Tracking Sheet,,.- <br /> ...,SPOILS w <br /> Storage Method U44AL MATERIALS/DEVELOPMENT <br /> Contamination Noted (y n " f t p� <br /> Storage Location Casing type <br /> Blank , TO _ft. Sc�een l ft. <br /> 1 <br /> r 4 Slot size . 016 <br /> r <br /> GROUTING Bags cement l! <br /> Buckets bentonite l <br /> Depth to water Bags sand/gravel <br /> Mix Ratios , f Filter Pack type/size <br /> Installation Method Surge Block: -,(y n- <br /> Quantity InstalledDiscussed with geologist: - (y n') <br /> Type of method <br /> E�f 29 29 <br /> ,r <br />