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ONITORING WELL INSTALLATION REPO <br /> CONS <br /> Date: n^ �— Total Depth <br /> S - Screen Length ((Tom) 5�--(to)_��- <br /> Premise Address: 5'�7 Filter Pack (from) <br /> 1 Bentonite (from)-11—(to)�— <br /> Well No.: Grout (from) Z�— <br /> `u �, Drilling rig type <br /> Inspector: Auger O.D.— box (circle one) <br /> Permit No. <br /> 1 <br /> Drilling Company: �� casino <br /> hei.ght ' <br /> Driller: <br /> Consultant <br /> ABCVE-GRCUND CtffiISTY 80X <br /> Geologist C0kFLETION apt tptgTlCN <br /> SPECIAL PERMiT INFO. grout <br /> tt, <br /> Distance to sewer lineft- <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> O <br /> lletAd = 'p <br /> SAMPLING tedcn <br /> g <br /> -�I -- r+wl Pack <br /> t Ry n (' IC�� O C� t - <br /> Holding Temperature =_ <br /> Method <br /> Screening Method <br /> Tracking Sheet • (Y/ n) <br /> tt. <br /> SPOILS <br /> aeeTFRiAT S/DEVEI.OPMENT <br /> Storage Method 11 <br /> Contamination Contamination Noted • (y/ Casing type - <br /> Storage Location Blank__�ft� Screen--�h <br /> Slot size <br /> II <br /> Bags cement <br /> GROU'I-ING ltm ��pku Buckets bentonite V <br /> Bagssand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios ° Surge Block: - (y/ n) <br /> Installation Method Discussed with geologist: - ( y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br /> 3y <br />