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kt-IONITORING WELL.INSTALLATION REP02er <br /> Date: //I boCONSTRUCTION <br /> Premise Address: 6 Total Depth b <br /> Screen Length (from)�,0 (to) b <br /> Well No.: `w Filter Pack (from) b_0, _(to) <br /> Inspector. _ p Bentonite (frons) `7 (to) <br /> Ins � <br /> P �`"""`�t Grout (from] -(to)� <br /> Drilling rigWe- <br /> Permit { S <br /> No. Auger O.D. Y.D. 5 <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant o ba '4 <br /> Geologisti-717T <br /> ABOVE-GRCUNO CHRZTY43OX <br /> CO MPLEf(ON CCMPLETICN <br /> SPECIAL PERMIT INFO. M4ffAWEdWG=rXj Sufact .� <br /> Distance to sewer line Qrout <br /> Domestic well on site - (y/'n j <br /> If yes, location and distance- 7 tt. <br /> SAMPLING s <br /> r v� sac�cn _ <br /> Holding Tem erature Y N — <br /> Method :t'r c,(c VAYW Pack <br /> Screening Method T> <br /> Tracking Sheet y n ) <br /> SPOILS <br /> Storage Method - S A?- L- MA'I'EUALS/DEVELOPMENT <br /> Contamination Noted - (y na <br /> Storage Location �,P�..- c Casing e "i� v� <br /> Blank 5 ft. Screen ft. <br /> Slot size ' 07-0 <br /> GROUTING Bags cement t-I-- <br /> f/ Buckets bentonite f -- 5_6�' <br /> Depth to water ,`t _ Bags sand/gravel <br /> Mix Ratios .i.�.�,�(_ Cz 'l Filter Pack type/size <br /> Installation Method Surge Block: - (y4r r ) <br /> Quantity Installed 3 Discussed with geo ogist: - 6� n) <br /> Type of method <br /> EH 29 29 <br />