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`' JNITORING WELL INSTALLATION REPOrn_ <br /> Date: f D-�� CONSTRUCTION - <br /> Premise Address: /moo � Total Depth (5 <br /> /LSU f� wo� Screen Length (from) 3 (to) Vs <br /> Well No.: " 7 Filter Pack (from) (to) S <br /> Bentonite (from) S 4 (to) 7 <br /> Inspector: Grout (from) (to) O <br /> Drilling rig type e►�:�c — I <br /> Permit No. �3 b Auger O.D. 9"12— I.D._ <br /> Drilling Compan <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> n ✓ � height <br /> Consultant <br /> 7,1 <br /> Geologistr� �N //-�[��jCc�, <br /> ABCVE-GROUND <br /> COMPLETION CNA X <br /> N COMPLET1CN <br /> SPECIAL PERMIT INFO. Ground Surlacs <br /> Distance to sewer line �$d grout <br /> Domestic well on site - ( n <br /> If yes, location and distance - ft' <br /> z' y 6 ft. <br /> ti 8 <br /> SAMPLING 1 = . <br /> slatted _„ � <br /> sac5on = <br /> Holding Temperature = <br /> Method V' pack <br /> YW <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) = w <br /> _..lLft. 1t. <br /> SPOILS ��l!,,��� � �- QQ /,, <br /> Storage Method I�IR..�5U4_ ' �1 MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y <br /> Storage Location ?act. d. Casing type ( v <br /> Blank t,_F ft. Screen ft. <br /> Slot size O LO <br /> GROUTINGBags cement t fi 2 <br /> Buckets bentonite <br /> Depth to water = 3� Bags sand/gravel <br /> Mix Ratios C±!� -t- -t 5n Filter Pack type/siz ?2 ?^ <br /> Installation Metho � Surge Block: - ( y n <br /> Quantity Installedq554 A- �6 4 -I- Discussed with geologist: - ( / n <br /> Type of method <br /> EH 29 29 <br /> 3126/ 5- IF COs <br />