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Y <br /> LONITORING WELL INSTALLATION REPO <br /> Date: (' ZOO l� <br /> CONS_ TRACTION <br /> Premise Address: \ <br /> p j TotalDepth�� <br /> Well No.: /Oy`(/ L�C.t�Gvt. Screen Leng h (from) <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite �(to)_� <br /> (from) $ _(to) S <br /> Grout (from) 05 (to) C� <br /> Permit No. M y/���� D <br /> �� rilling rig type C.t.,E <br /> Auger O.D.�g I.D. <br /> Drilling company: q . t�`nGrp Completion - Stove pipe/christie box (circle one) <br /> Driller: � //'iCs�•- - �PrJ� WW <br /> wv casing <br /> Consultant �/� r/ height <br /> Geologist_ Age i'f/tiJ`cP�✓ <br /> ABOVE-GACUND <br /> SPECIAL PERMIT INFO. COWLETON (i=x <br /> HR* <br /> Ground Surface <br /> Distance to sewer line ,� �Q � <br /> Domestic well on site - ( y n grout <br /> If yes, location and distance- l 5 <br /> La. h- <br /> SAMPLING = m <br /> slotted = ! c <br /> Holding Temperature — `14 — � auction - S <br /> Method <br /> Screening Method a"vel pac <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS 2L <br /> CC 36 <br /> Storage Method OS � 0 <br /> Contamination Noted - (y n MATERIALIVE -.OPMENT <br /> Storage Location ,t C e... Pve <br /> Casing type dc <br /> Blank�_g, Screener ft. <br /> GROUTING Slot size_ a yd <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios_ Iva_ Bags sand/gravel = jpil- <br /> Installation Metnoa Filter Pack type/size e i <br /> Quantity Installed Surge Block: - (y n <br /> Discussed with geo st•. -dn ) <br /> EH 29 29 Type of method <br />