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r- NITORING WELL INkALLATION REPO <br /> 21 <br /> Date: Z.S �� CONSTRUCTION <br /> Premise Address: s C' Total Depth 7 <br /> Screen Length (from) (to) /Well No.: Filter Pack (from) (to) t C� <br /> Bentonite (from) t CD (to)� <br /> Inspector: Grout (from) 8' _(to) O <br /> Drilling rig type �- <br /> Permit No. 1" 7 Auger O.D. I.D. 8�_ <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> . casing . <br /> Driller•. -t- / height <br /> Consultant <br /> X:�e <br /> GeologistASOYE'�ROUND CHAtM43OX <br /> COMPLETION COMPLETION <br /> ground S <br /> SPECIAL PERMIT INFO. <br /> proof <br /> Distance to sewer line t o 5a <br /> Domestic well on site - (y/ ft. <br /> If yes, location and distance - tt' <br /> .LZ ft. <br /> = o <br /> SAMPLING +man <br /> Holding Temperatureo ; <br /> Method <br /> Screening Method m J AS <br /> Tracking Sheet -C% n) fL `" — <br /> SPOILS <br /> Storage Method f MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Casing ryPe <br /> Storage Location D'h ./�-� 1 . ft. <br /> Blank--j-Z.,—ft- Screen _ <br /> Slot size -01 <br /> g&QUTINq Bags cement 4q ' Lip - <br /> Buckets bentonite <br /> • ` �S Bags sand/gravel (o- <br /> Depth to water a L <br /> Filter N4 k typesize <br /> Mix Ratios Surge Block: n) <br /> Installation Method Discussed with geologist: - ((�/ n) <br /> Quantity Installed n" <br /> Type of method <br /> '12 3l9, <br />