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-..rtONITORING WELL INSTALLATION REP(.-_1 <br /> Date:_/ 9 CONSTRUCTION <br /> Premise Address: 7 G Z 7 v H"'�, Total Depth l <br /> Screen Length (from) (to) <br /> Well No.: i -�(��t fA�.o�Filter Pack (from) (to)� <br /> Bentonite (from) (to) 7- <br /> Inspector: <br /> Inspector: Grout (from) L (to)Ay� <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Drilling Company: 'stie b ( <br /> Completion - Stove pipe/ circle one) <br /> Driller: I casing <br /> � IT7 Theight <br /> —EFW-f <br /> Consultant pp <br /> 7 <br /> Geologist . 1.1_ <br /> ABOVE-GROUND <br /> COMPLETION Ct'iPLE IOX <br /> COMMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y ) ft. <br /> If yes, location and distance - <br /> _ c <br /> SAMPLING <br /> slotted _ c <br /> aecton = <br /> Holding Ten1perature = gravel P <br /> Method 1 S A� _ <br /> ack <br /> Screening Method_ <br /> Tracking Sheet n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ./ <br /> Storage Location 4� ) w�f Casing type atpt/C� <br /> Blank ft. Screen ft. <br /> Slot size v OZa <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> xrlue <br /> Quantity Installed V Discussed with geolo st: 0� /�'f n ) <br /> Type of method - Icst& &A., I� A'� <br /> EH 29 29 <br />