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WONITORING WELL INSTALLATION REP* <br /> Date:_ �Ly—/S // / CONSTRUCTION <br /> Premise Address: /(0�4/ �9p i`�� Total Depth <br /> Screen Length (from) (to) 1-5 <br /> Well No.: Filter Pack (from) 30 (to) <br /> Bentonite (from) A (to) <br /> Inspector: Grout (from) /Z (to) <br /> q Drilling rig type Oft F S <br /> Permit No. ��eel 11 Sd Auger O.D. e I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> .,� -- <br /> Driller: G'//,GL 7` L casing <br /> GEa height <br /> Consultant + T <br /> Geologist - r <br /> ABOVE-GROUND CtW1.S1Y-80X <br /> COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlaca <br /> Distance to sewer line grout <br /> Domestic well on site - ( YO <br /> /y <br /> If yes, location and distance - n. <br /> n. <br /> Win. <br /> = m <br /> _ m <br /> SAMPLINGT` g <br /> slottad <br /> Holding Temperature = VI„EW PackMethod _ <br /> Screening Method - <br /> Tracking Sheet - (y/ n ) 2^ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Not - ( y/ n ) <br /> Storage Location Casing type <br /> Blank /S ft. Screen <br /> Slot size - c o o <br /> GROUTING ��4tlags cement 14 --t- <br /> Buckets <br /> Buckets bentonite / <br /> Depth to water 7 Bags sand/gravel 5nr- <br /> Mix RatiosFilter Pack type/size /2- <br /> Installation Method DRe«— Surge Block: - (y n <br /> Quantity Installed �ZS -+- I S -l- 15 Discussed w th geo ogrst: - ( / n <br /> Type of method <br /> EH 29 29 <br />