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')NITORING WELL INSTALLATION REPO, <br /> Date:. CONSTRUCTION <br /> CONSTRUCTION <br /> Premise Address: / YO Total Depth Z16 <br /> /C�/ /l� Screen Length (from) 24 (to)_ <br /> Well No.: is 01t) Filter Pack (from) 783 (to)j _ <br /> � � /D Bentonite (from) (to) <br /> 'Y1C.2 <br /> Inspector: lGrout (from)_! (to) c� <br /> ` Drilling rig type S <br /> Permit No. V Auger O.D. _ <br /> n S� Completion - Stove pipe/ s� c (circle one) <br /> Drilling Company: f7" <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist ba, <br /> ABOVE-GROUND <br /> COMPLETION C <br /> COMPLETION PN <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line -� <br /> Domestic well on site - y(/(y n ft• <br /> If yes, location and distanc ft. <br /> CD <br /> — c <br /> — c <br /> slotted <br /> SAMPLING sacdon = 2 <br /> Holding Tem erasure d gr'vol pack, <br /> Method AIP2 _ <br /> Screening Method <br /> Tracking Sheet - y�/n ) 2 iR <br /> ft. <br /> SPOILS <br /> Storage Method �l��s MATERIALS/DEVELOPMENT <br /> Contamination Noted - y ) // <br /> Storage Location //h—� Casing type 2- Pl�L/ <br /> Blank___3 ft. Screen <br /> Slot size . D/D <br /> GROUTING Bags cement 2— <br /> Buckets bentonite l <br /> Depth to water " � 1 Bags sand/gravel <br /> Mix Ratios � C Filter Pack type/size 1'2� <br /> Installation Method Surge Block: - (y <br /> Quantity Installed < J_ f _ Discussed with geol gist: - n ) <br /> Type of method <br />