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'`IONITORING WELL INSTALLATION REPO <br /> Date: 2-o6 <0 CONSTRUCTION <br /> I r �� <br /> Premise Address: A�,V 6N Total Depth 15 <br /> Screen Length (from)_ (to) <br /> Well No.: 14VIL0 Filter Pack (from) 75 (to) <br /> Bentonite (from) (to) <br /> Inspector: i A— Grout (from)—(to) <br /> Drilling rig type <br /> Permit No. J <<z— Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: E casing <br /> height <br /> Consultant ,Q� �� -�• <br /> Geologist <br /> ABOVE-GROUND Ct1R*'rY43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer ling �Ae6' + <br /> Domestic well on site - ( y(D 5 S to n <br /> If yes, location and distance - <br /> � aLfS� <br /> = n <br /> SAMPLING y( slotted44 C- <br /> = $ <br /> Holding Temperature <br /> Method .JI"_ _ p <br /> gmy9i pack <br /> Screening Method <br /> Tracking Sheet -(jjPn ) <br /> �11. <br /> SPOILS <br /> Storage Method JSS�.�C 6LA�dA StT� MATERIALS/DEVELOPMENT <br /> Contamination Noted�j� ) A_ /� , <br /> Storage Location G e �-� Hca^ Casing type z 'cu -Icy r 1/c— <br /> Blank ?O fr. Screen <br /> Slot size .AZn <br /> GROUTING Bags cement <br /> Buckets bentonite "� <br /> Depth to water 7 Bags sand/gravel <br /> Mix Ratios ,Iw) + M 50 Filter Pack type/size 3 <br /> Installation MethodSurge Block: - (y <br /> Quantity Installed CC= y 'rs, Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> 120 OG <br /> 'Poe — <br />