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IRONITORING WELL INSTALLATION REPS <br /> Date: �Nlyi 9i ��L CONSTRUCTION Iq <br /> Premise Address: Yo.OVJ[/_/�� Total Depth <br /> Screen Length (from) IQ. to) <br /> Well No.: �� c� r-T� � '� 4�s �I 1-' � Filter Pack (from) (to) <br /> Bentonite (from) 4 ,r„(to) 2, <br /> Inspector. Grout (from) Z, (to) ,D <br /> Drilling rig type <br /> Permit No. 92-2,31 1 Auger O.D. 10 I.D. <br /> rr Completion - Stove pipe/christie boi)(circle one) <br /> Drilling Company. 4 �t'�7ALi `— <br /> Driller: casing <br /> pp T— �� height <br /> Consultant / lLk ' <br /> Geologist � 1� �IJ0 - <br /> ABOVE-GRCUND CtWISTY BOX <br /> COMPLETION COMPLEI ICN <br /> SPECIAL PERMIT INFO. Ground Surtan T <br /> Distance to sewer line " grout <br /> Domestic well on site • y n ) <br /> If yes, location and distance - ft. <br /> n. <br /> n. <br /> _ m <br /> _ e <br /> o <br /> SAMPLING slot i _ 3 <br /> sadcn <br /> Holding Temperature <br /> gravW Pack <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y <br /> n. = M <br /> SPOILS <br /> Storage Method {l ' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/�fi <br /> Storage Location Casing type <br /> Blank____S ft. Screen 15 ft. <br /> Slot size -0_ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 7� h4 <br /> Mix Ratios t, V M Wim. &.-) ,f) I Filter Pack type/size "- <br /> Installation Method ��— ' Surge Block: - (y <br /> Quantity Installed Discussed with geologist: . ( y/fin)) <br /> Type of method <br /> EH 29 29 <br />