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•MONITORING WELL INSTALLATION ROT <br /> Date: I�d CONSTRUCTION <br /> Premise Address:_) Y® 6 Al 4�xt,)VZ 0' ' Total Depth ` <br /> l 3 Screen Length (fr m) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)—(to)— <br /> Inspector: Grout (from) (to) <br /> Drilling rig type -' ?7k oar ,i,- <br /> Permit No._0 n� �� Auger O.D. <br /> 1 Completion- Stove pipe/christie-box (circle one) <br /> Drilling Company: K2ai <br /> Driller: ti casing <br /> ` , ) height <br /> Consultant 1���/tv/./ l T <br /> Geologist T <br /> ABOVE GR D <br /> ccwLE'nctJ Ct�11 80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground gyylxy <br /> Distance to sewer line L,,,- <br /> Domestic well on site - (y/'rI h <br /> If yes, location and distance - <br /> ft n. <br /> F <br /> O <br /> C <br /> SAMPLING <br /> abttad v. — c <br /> sac�onHolding <br /> Method T m-et���+ <br /> gmvw Pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ' <br /> Storage Location ,-J IA- Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios t>T r°7: ,Yr T Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />