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ONITORING WELL INSTALLATION REPO' <br /> I <br /> Date: d, % %2 CONSTRUCTION <br /> Premise Ad ress: ,7;D fo • uT (, f Total Depth ZC7 <br /> Screen Length (from) $C (to) f5- <br /> Well No.: <br /> WellNo.: !e �bh���-92- Filter Pack (from)��(to)� <br /> Bentonite (from) (to) '!_ 7 <br /> Inspector: �1tJSC�tJ Grout (from) 2 �5 (to) O <br /> Drilling rig type <br /> Permit No, Auger O.D. I)" I.D. <br /> ( � Completion - Stove pip Ichristie boz (c' cle one) <br /> Drilling Company: ' /6u' L/,w_ <br /> Driller: V(V' casing <br /> �F height <br /> Consultant //(ybl n, <br /> Geologist U(lil'� U�rIR _ - T <br /> ABOVE-GACUND 17 <br /> CHAISTY-80X <br /> COhiPLcTION CCMPLEEMON <br /> SPECIAL PERMIT INFO, Ground Sudan <br /> Distance to sewer line ����� grout <br /> Domestic well on site - ((y)/ n ) <br /> it, <br /> If yes, location and distance - <br /> SAMPLING slorod <br /> soc�cn — <br /> Holding Temper lure = F <br /> Method 0 _ <br /> Screening Method <br /> Tracking Sheet - (y/n')• x; <br /> ft. = fL <br /> SPOILS <br /> Storage Method d < "? MATERIALS/DEVELOPMENT <br /> Contamination Noted • (y/7n <br /> Storage Location ci Casing type A 1 <br /> U Blank ft. Screen ft. <br /> Slot size ,CZ- <br /> GROUTING Bags cement <br /> Buckets bentonite L; t <br /> Depth to water Bags sand/gravel M4 11v <br /> Mix Ratios J �_ ( t - Y �� Filter Pack type/size /fly,- - <br /> Installatlon Methbd Surge Block: - ( y/ i ) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> J <br />