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rQNITORING WELL INSTALLATION REPO <br /> Date: Z% CONSTRUCTION <br /> Premise Address: azte Total Depth 4� <br /> Screen Length (from) (to)=- <br /> Well No.: Z Filter Pack (from) 2 (to) 7 L <br /> Bentonite (from) 41P 12- (to)r/¢_ <br /> Inspector. 2 Grout (from) !O (to) d <br /> ��l0 7 Drilling ng type Z <br /> Permit No. Auger O.D. WMA I.D. <br /> A144�A4AVr Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. £ �►� height <br /> Consultant <br /> Geologist ABOVE-GROUND CHRIM4OX <br /> COMPLETION COMPLETION <br /> Ground Surf <br /> SPECIAL PERMIT INFO. <br /> Qr <br /> Distance to sewer line ;7j" z n. <br /> Domestic well on site - (y,D n <br /> If yes, location and distance - 1�n, _ <br /> .4, 0 <br /> �• O <br /> sbttad � = c <br /> SAMPLING �On <br /> vol Pack <br /> Holding;Te pe a . <br /> Method <br /> Screening ethod �� '� 2 <br /> �.L.-.� — tt. <br /> Tracking Sheet - y n) tt. <br /> Storage Method ''EK /DE ZgpMENT 3 <br /> Contamination Noted <br /> Stiorage Location Blank ^1Z fL Screen ft- <br /> q -`t slot size 0 <br /> ` Bags cement <br /> GROUTING ' ., :.. c; Buckets bentonite.` <br /> !Z �� Bags sand/gravel <br /> Depth to water w., Pilte l lick typ <br /> Mix Ratios Flo Surge Block: - n) <br /> Installation Method Discussed with&et>ilogist: - n') <br /> \kQWtiry Installed Type of methodi <br />