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MONITORING WELL INSTALLATION REPOnL <br /> Date: /Q d a Q �,( CONSTRUCTION <br /> Premise Address : G l� V ' Total Depth <br /> ¢ Screen Length (from) (to) 5 <br /> Well No. : 14W�� 0 Filter Pack (from) /17 (to) 5 <br /> Bentonite (from) 3 (to <br /> Inspector: (from) (to). 0 <br /> Drilling rig type v 14194j <br /> D , 2 <br /> Permit No. 'j' Auger O.D. I .D. I <br /> Drilling /� J /� Completion - Stove pipe/christie box (circle one) <br /> Company: <br /> �J�/y -(.G!/ <br /> Driller: /� — T vim/ t casing <br /> height <br /> Consultant <br /> Geologist �✓ " `"` �� T <br /> ABOVE-GRCUNO C71AlSTY-BOX <br /> COMPLETION OMPLETIO <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to SW&L*nine 1 - proof .. <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - ft' <br /> tp <br /> ft. <br /> SAMPLING slonad = ? " c <br /> secjon ^[ <br /> Holding Temperature _ gr&V%W P <br /> aCK <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> ft. <br /> SPOILS �6 <br /> Storage Method �ss -e O /l MATERIALS/DEVELOPMENT <br /> Contamination Noted ' " <br /> Storage Location O � r Casing type <br /> Blank �5 ft. y�Screen Od ft. <br /> Slot siz <br /> GROUTING Bags c <br /> Buckets bentonite <br /> Depth to water d03 Bags sand/gravel <br /> Mix Ratios /�,fi 1 Filter Pack type/size 3 <br /> Installation Method 7A Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y s ) <br /> Type of method <br /> EH 29 29 <br /> 3 <br />