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NNW <br /> MONITORING WELL INSTALLATION REPOn f <br /> Date: 2,c O /w CONSTRUCTION <br /> Premise Address:_ .-.�W CL'-Z r" Z Total Depth <br /> Screen Length (from) jot5 to <br /> Well No.: v Filter Pack (from) !OS (to) Z <br /> Bentonite (from)--4,2,- <br /> 2 (to) Z <br /> Inspector: Grout (from) (to) O <br /> 4 Drilling rig type <br /> Permit No. Auger O.D. <br /> b� Completion- Stove pipe c stie box (circle one) <br /> Drilling Com pan/y: <br /> Driller: C/U �t1, i��l��` t �� casing <br /> height <br /> Consultant_ C T7 T <br /> / T <br /> Geologist / �'� .r T <br /> ABOVE-GRCUNQ <br /> COMPLETION CHRIS7Y-8OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (D n ) <br /> If yes, location and distance - ✓�� ��� Q� ft. 2 ft. <br /> — p <br /> — c <br /> SAMPLING <br /> slotted <br /> section <br /> Holding Temperature <br /> a — <br /> Method = V" P <br /> ack <br /> Screening Method tl IA _ <br /> Tracking Sheet n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) it v <br /> Storage Location dx r.-Z;4Q Casing type <br /> Blank ft. Screen ft. <br /> Slot size . O2.0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel—7 <br /> Mix Ratios 9q 4 7 C Filter Pack type/size <br /> Installation Method Surge Block: - (yTost: <br /> Quantity Installed tN Discussed with ge - ( y n ) <br /> Type of method <br /> EH 29 29 <br />