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ONITORING WELL INSTALLATION REPO* <br /> Date: CONSTRUCTION <br /> Premise Address: /o NII 5't .CC Total Depth 173 <br /> Screen Length (from) /'73' (to) X43 <br /> Well No.: 7 Filter Pack (from) 172 (to) /S"U <br /> Bentonite (from) // (to).�; <br /> Inspector. � ��� . Grout (from) /v7'7 (to) <br /> Drilling rig typei o�— <br /> Permit No. �3" �SG Auger O.D. I.D. <br /> Completion - Stove pipe/ch istie box (circle one) <br /> Drilling Company: 12lcru�_ <br /> Driller: 1IT77 T height casing <br /> T <br /> Consultant L� 4 e � �-J <br /> Geologist �^ T <br /> ABOVE-GACUND CHRZTY-acx <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SWacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) C C'4 `�� ft. <br /> If yes, location and distance - /5o g- <br /> f�ft. <br /> +i = <br /> �4 O <br /> V' + <br /> O <br /> SAMPLING .brei = E <br /> sac*on <br /> Holding Temperature 'n' Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet • ( y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/n ) a <br /> Storage Location Casing type <br /> Blank !S7 ft. Screen Z ft. <br /> Slot size -03,C) <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size #3 <br /> Installation Method Surge Block: - 6''/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />