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WNITORING WELL INSTALLATION REPO <br /> Date:�ZS (( CONSTRUCTION <br /> Premise Address: /& bl"Auc x a d Total Depth <br /> Screen Length (from) 37.5— (to) 3 Z <br /> Well No.: SuJ' /O Z, Filter Pack (from) 37• :- (to) 30 <br /> Bentonite (from)_3y (to) ZFr <br /> Inspector: Grout (from) 2£r (to) <br /> Drilling ng type <br /> Permit No. 5t`'pp oo5'1-(32Z Auger O.D. S"I I.D. N ' <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist ABOVE-GROUND <br /> COMPLETION COMPLE71CN <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> n. <br /> = m <br /> _ p <br /> O <br /> C <br /> O <br /> SAMPLING <br /> aacton <br /> Holding Temperature gr+ylg Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> Blank fr. Screen fr• <br /> Slot size <br /> GROUTING bjt07 Bags cement <br /> Nit 2 Buckets bentonite <br /> Depth to water 1 Z A S� dlV Bags sand/gravel <br /> Mix Ratios 30 L y t Filter Pack type/size <br /> Installation Method s Surge Block: - (y/ n) <br /> Quantity Installed 4D r a Discussed with geologist: - (y/ n) <br /> e 4 Type of method <br /> W <br /> EH 29 29 e <br /> rhe <br />