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E: �4ONITORING WELL INSTALLATION REPOt r:= <br /> iq <br /> Date: I s % CONSTRUCTION <br /> 5 J <br /> Premise Address: AI.15�J�ZO3d Total Depth ! <br /> E: _Ilow Screen Length (from) (to) <br /> Well No.: �' �l Filter Pack (from) (to) — <br /> Pill Bentonite (from) 7 (to) 72- 1 <br /> Inspector: Grout (from) 7Z (to) <br /> i Drilling rig type <br /> Permit,No. 4-< �" Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Drille I�: 1441C. _ casing <br /> i� height <br /> Consultant GG <br /> T7 T <br /> �I <br /> Geologist �C" <br /> E COMPLETION CHS*TY-BOX <br /> COMPLETIO <br /> SPECIAL PERMIT INFO: .« -.t `: » - Ground Surface <br /> grout".K. <br /> 'Distance to-sewer Im- a �....� , <br /> Domestic well on site- { Y _ a '" ` • ham-- 2-O . <br /> If yes;location and-distance - �• II <br /> ID <br /> SAMPLING <br /> �'•). '",-;:uwr'•,y!.. E..+� +,. '..-- �„r'; ,-4•:•.� '.fir -, ��OSt9d <br /> tHold' g Temper `� - A � ViW pack <br /> Meth d <br /> Screening Method <br /> Tracking Sheet n) _° - •` ` _ <br /> SPOILS <br /> Storage Method n MATE RIALS/DEVELOPMENT <br /> Contamination Noted-,( y/n ) ;ti G^- k% �`+ 46 <br /> 'Storage Location Casing type JCS <br /> Blank ft. Screen <br /> A <br /> Slot sizes (Q <br /> GROUTING Bags cement Ti,9f <br /> Buckets bentonite <br /> Depth,to water`'. ` '?� y� Bags:sand/gravel <br /> Mix Ratios '' �x , Filter Pack type/size Z l6? <br /> ' Install'aton Method Sorge Block: -'( ' <br /> Quantity Installed t Discussed with g�eYogist: - n j <br /> �- <br /> • �� - ,� a . Type of method _ . <br /> Gy <br /> EH 2929 _ <br /> �, h <br />