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'MONITORING WELL INSTALLATION REPS' <br /> Date: b`*, 2— "017 '" CONSTRUCTION <br /> Premise Address: <br /> E 44�e'-Z�< Total DepthLAP <br /> Screen Length (from) _(to) Z <br /> Well No.: /Y� Filter Pack (from) (to)�— <br /> Bentonite (from) (to)-- <br /> Inspector: Grout (from) (to) O <br /> Drilling rig type /'�S T LTI� <br /> Permit No. �P � Auger O.D. Fs' I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (��� <br /> Driller: k� 7- c%�` casing <br /> height <br /> Consultant /�GC <br /> Geologist <br /> ABOVE-GROUND CHRIS Y43ox <br /> " l COMPLETION OMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> rout <br /> Domestic well on site (y n t' 2-' ft. <br /> If yes, location and distance - 28 ZL ft. <br /> SAMPLING slotted <br /> section — <br /> Holding Temperature _ _ SmvW pack <br /> Method 6"0 <br /> Screening Method O✓M <br /> Tracking Sheet n ) � x <br /> SPOILS <br /> Storage Method SS ��� VAI MATERIALS/DEVELOPMENT <br /> Contamination Noted - n )� 'k✓1� P 7 f� G-() <br /> Storage Location A A� Nu/Cd�� Casing type Z <br /> Blank ZQ ft. Screen 20 ft. <br /> Slot size <br /> GROUTING Bags cement /N <br /> Buckets bentoniteL- <br /> Depth to water 3 s Bags sand/gravel �- <br /> Mix Ratios �(/ Q� �' / Filter Pack type/size - '> <br /> Installation Method' K Surge Block: - (y�) <br /> Quantity Installed Discussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 <br />