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'40NITORING WELL INSTALLATION REP, ''' <br /> Date: 7/V 4CONSTRUCTION <br /> l ,, i <br /> Premise Address: l'/ 1sn'�"' "�`�� Total Depth -E'4 <br /> ,iScreen Length (from) '1/ (to) Y <br /> Well No.: G 2- Filter Pack (from) JZ (to) <br /> Bentonite (from) (to) 3 <fl- <br /> Inspector: Grout (from) (to) <br /> S� �D�� Z � � Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 661 <br /> Driller: VL C, casing <br /> /� � 1 height <br /> Consultant /'11i <br /> Geologist e TZ.. — <br /> ABOVE-GROUND <br /> COhPLET10N C}iAlSTY-80X <br /> / d L&'i <br /> SPECIAL PERMIT INFO. aC)`'r � 26 - VQr �a c 1 ! Cirourd Surface COMPL_EnON <br /> ZG 4-eeu e)k y -f O -'�6 i <br /> Distance to sewer line proof <br /> Domestic well on site - ( y/ n ) ft <br /> If yes, location and distance - <br /> 1Y. ft. <br /> — m <br /> — o <br /> — m <br /> SAMPLING <br /> slottad <br /> aoc',ion _ <br /> Holding Temperature <br /> Method }' _ 9MvW Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) ;z~ <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite 2 bc,,iS <br /> Depth to water Bags sand/gravelIle Lf� 1 -*3 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: -ry/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />