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1 V(6NITORING WELL INSTALLATION REP n <br /> y <br /> Date: C, 6 CONSTRUCTION 24Premise Address:—�,Sqb S Total Depth <br /> / C Screen Length (from) (to) <br /> Well No.: W4 lJ f Filter Pack (from) (to) <br /> Bentonite��y�,(from) (to)2_ <br /> Inspector: 4Cs=Ut G' (fro ) LA�— <br /> Drilling rig type L'i" l <br /> Permit No. Auger O.D. I.D. <br /> / Completion- Stove pipe/christie box Circle one) <br /> Drilling Company: <br /> Driller:—/4"i casing <br /> Consultant height T <br /> T <br /> Geologist AE&E- ,ROUND <br /> COMPLETION CtiAtSTY-80X <br /> COMPLE IO <br /> SPECIAL PERMIT INFO. Ground Sufacs <br /> Distance to sewer line L�D grout <br /> Domestic well on site - (y Z • n, <br /> If yes, location and distance - <br /> SAMPLING slotted = c <br /> tecdon <br /> Holding Temperature : .= _ v.1 <br /> Method �� P <br /> Zi <br /> Screening Method ✓ —_ <br /> Tracking Sheet - y n) '4 — <br /> it. <br /> SPOILS � <br /> Storage Methods MATE /DEVELOPMENT <br /> Contamination Noted - (y,(3) 2% <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size 02.0 <br /> GROUTING Bags cement <br /> /lByakft's bentonite_ <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Iy Filter Pack type/size <br /> Installation Method A4X Surge Block: - (y n <br /> Quantity Installed �` Discussed with geo ogist: - (y <br /> Type of method �- <br /> EH 29 29 <br />