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\r <br /> `:iONITORING WELL INSTALLATION REPOA <br /> Date: Z loo& CONSTRUCTION <br /> Premise Address: Ga Total Depth 75 <br /> Screen Length (from) - (to) _9.5 <br /> Well No.: L'C Filter Pack (from) (to) (0 7 <br /> Bentonite (from) (to)__(y1 -_ - - <br /> Inspector: Grout (from) (Of (to) <br /> Drilling rig type CW 7 q5 _ _ <br /> Permit No. �/C (�l/� Auger O.D. �2 <br /> Completion - Stove p' a/christie box (circle one) <br /> Drilling;ompany: <br /> F <br /> Driller: casing <br /> height <br /> Consultant ✓- _. T <br /> Geologist /P- � / �" - T <br /> ABOVE-GROUND CtiH <br /> COMPLfbN COMPLETION <br /> SPECIAL PERMIT INFO. +rd Surf <br /> Distance to sewer line d) grout <br /> Domestic well on site - (y (3 e� 6 n <br /> If yes, location and distance - f' <br /> W _ c <br /> SAMPLING <br /> alottad <br /> archon .• __ <br /> Holding Temperature <br /> Method = <br /> graval pack <br /> Screening Method <br /> Tracking Sheet - n ) <br /> -V1 n. = n. <br /> SPOILS L // -7TStorage Method 55s� y6C MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n ) p � <br /> Storage Location NX' cauut /*� typeZ� 5 cL 46 P J C-- <br /> / Blank .S ft. Screen___5 <br /> Slot size .O zp <br /> GROUTING Bags cement = 41 4 t8'4"A4 <br /> Buckets bentonite <br /> Depth to water z Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y� <br /> Quantity Installed Discussed with geo ogist: - (y/ n <br /> Type of method <br /> EH 29 29 <br /> �_Z7 D6n <br /> 30 -a 6(A) ✓C- �sf <br />