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`„IONITORING WELL INSTALLATION REPb,,, <br /> Date: ?/��! 3 CONSTRUCTION <br /> Premise Address:/3q -S. <br /> Total Depth bd, <br /> Screen Length (from) GO (to) <br /> Well No.: Filter Pack (from) 6"o (to)33 <br /> Bentonite (from) 314 _(to) 31 <br /> Inspector: � -f� Grout (from) 2 1 (to) <br /> � <br /> tp Drilling rig type <br /> Permit No. l�6/ Auger O.D. I.D. / <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:5 <br /> Driller:_ ��� casing - -� <br /> height <br /> Consultant K:1 T.� <br /> 0"17T7T- T <br /> Geologist G ,uJ► .. <br /> ABOVE-GROUND \� <br /> COMPLETION CNFitSTY-80X <br /> �� COMPLETION <br /> SPECIAL PERMIT INFO. yy,, Ground Surface <br /> Distance to sewer line (A � grout <br /> Domestic well on site - (y n) <br /> If yes, location and distance - ft. <br /> SAMPLING M`• <br /> s <br /> aodcn <br /> S <br /> Holding Temperature <br /> Method `� S "` — ¢"'9I Pack <br /> Screening Method <br /> Tracking Sheet y/ n ) <br /> _1a ft. <br /> SPOILS <br /> Storage Method 55�. � � MATERIALS/DEVELOPMENT <br /> Contamination Noted - ) <br /> Storage Location - Casing type N e�UC� <br /> Blank S� ft. Screen 2X ft. <br /> Slot size .07-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n <br /> Quantity Installed Discussed with geo gist: - 6/ n) <br /> Type of method <br /> EH 29 29 <br />