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['JNITORING WELL INSTALLATION REPOT, <br /> Date: 2— 22^ 03 LM�N� CONSTRUCTION <br /> Premise Address: Total Depth $O <br /> Screen Length (from) YO (to) <br /> Well No.: Filter Pack (from) ac) (to) Co <br /> Bentonite (from) to (to) !os <br /> Inspector: Grout (from) !05 (to) O <br /> Drilling rig type <br /> Permit No. Auger O.D. b 3) I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> L <br /> Driller: ROU t Z casing <br /> height <br /> Consultant �G IE <br /> GeologisABOVEGROUND <br /> OOWPLETION i <br /> iN <br /> SPECIAL PERMIT INFO. Ground Sumac* <br /> ? pfout <br /> Distance to sewer line <br /> Domestic well on site - n ) <br /> If yes, location and distance - <br /> t ft. <br /> — m <br /> 0 <br /> SAMPLING slotted <br /> &*cion '- <br /> Holding Temperature <br /> Method &o�•� oy'^ <br /> Screening Method <br /> Tracking Sheet - G7n ) <br /> tt. <br /> SPOILS <br /> Storage MethodSS MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location Casing type <br /> Blank�'D rft. Screen l'1� ft• <br /> Slot size t7.2�' <br /> GROUTING Bags cement 30 <br /> Buckets bentonite 30 <br /> Depth to water �- �� Bags sand/gravel <br /> Mix Ratios 7 t 2$ <br /> ljc../ Filter Pack type/size �- 1 Z' <br /> Installation Meth d dcvrre�d — Surge Block: - (y/ n )—N A <br /> Quantity Installed ///%rZ — �Z�O Discussed with geologist - (y n� <br /> Type of method <br /> ,/'4 <br /> EH <br /> EH 29 29 <br />