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voNITORING WELL INSTALLATION REPG%o4' <br /> Date: //���( �`� CONSTRUCTION <br /> Premise Address: /a-�� S ' �/!//?��7'� �/• Total Depth x U, <br /> p Screen Length (from) (to) <br /> Well No.: S/� -I � Filter Pack (from) (to) <br /> I Bentonite (froth) (to) <br /> Inspector. Sf�/�/� 5� Grout (from)�(to)t <br /> per^ Drilling rig type <br /> Permit No. _ �/J Auger O.D. g" I.D. <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company-. (�7 <br /> Driller: J�� �UYYi� � he_ght casing <br /> �� --�� <br /> Consultant <br /> Geologist (�jfIGL�I L� ABOVE-GACUND <br /> COMPLETION CHRM Y-Box <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfaerr <br /> Distance to sewer line grout <br /> Domestic well on site - (y n) <br /> If yes, location and distance - ft. <br /> n ft. <br /> = e <br /> SAMPLING <br /> Blotted <br /> socicn <br /> Holding Temppe�,rature <br /> 7Q D� .F <br /> Method ( XX r Ito — Ram D <br /> ack <br /> Screening Method A1r4 <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method SS /)YDS MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - ()P/ n ) <br /> Storage Location 42�� Si 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 Rados Filter Pack type/size <br /> Installation Method tfL"/19/P Surge Block: - (y/ n ) <br /> Quantity installed Discussed with geologist: - (y/ n) <br /> EH 29 29 <br /> ����� �� nG/� Type of method <br /> �py�y�f /-t' U <br /> 4" <br />