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ONITORING WELL INSTALLATION REPC <br /> Date: -7//�/�/ CONSTRUCTION <br /> pp � <br /> Premise Address:F � �i ��= il'- inr.W 7meg Total Depth U <br /> Screen Length (from) (to) _ <br /> Well No.: Filter Pack (from) '70' (to) T <br /> Bentonite (from) S7 (to) ' <br /> Inspector: /� Grout (from) (to) <br /> c Drilling rig type2t t fuAtj <br /> — <br /> Permit No. Auger O.D. I.D. x 1 <br /> Completion,!Stove pipe christie box (circle one) <br /> Drilling Company: D ckd �iyl p <br /> Driller: 1-1,2( casing <br /> height <br /> Consultant_ . <br /> T <br /> Geologist ti ABOVE-GROUND <br /> COMPLETION CFiRIS'T'Y-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> proof <br /> Distance to sewer line <br /> Domestic well on site - n ) ft. <br /> If yes, location and dist ce - ft- <br /> -� <br /> b <br /> r <br /> O <br /> SAMPLING slotted <br /> wc4on _ <br /> Holding Temperature 01A = �"�Pack <br /> Method =_ <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n <br /> Storage Location 6'� - Casing type <br /> Blank ( �, ft. Screen Z <br /> Slot size U <br /> GROUTING Bags cement /S tf P <br /> / Buckets bentonite / F,f <br /> Depth to water '7 o Bags sand/gravel j l/0 4, <br /> Mix Ratios /!S:- c-& y Filter Pack type/ ize <br /> Installation Method n Surge Block: -L ' <br /> 2 n ) <br /> Quantity Installed / 1,//j Discussed with geologist: - a)/ n ) <br /> Type of method <br />