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�a y <br /> VONITORING WELL INSTALLATION REP <br /> i`'�// G� .- .Irl ,r .r i . N1► <br /> Date: il / CONSTRUCTION <br /> Premise Address: Z�' -"r✓�A��IU Total Depth._6 0 - <br /> d��� - Screen Length (from) (to) b <br /> Well No.: . Filter Pack (from) d (to)�� <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> a Drilling rig type ( i <br /> Permit No. �� Auger O.D. I.D. <br /> r' Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller• casing <br /> T <br /> height <br /> i <br /> Consultant <br /> Geologist <br /> ABCVE4RC:UND CHF M-aOX <br /> CCMPLETCN CCMPLETICN <br /> SPECIAL PERMIT INFO. end Surra" <br /> r <br /> Distance to sewer line � Grout <br /> Domestic well on site - (y <br /> If yes, location and distance - - ft- <br /> SAMPLING y _ ..__ � to slorad <br /> a 'cn <br /> Holding Temp rature 0.0 gavalpadc <br /> Method ' x <br /> i <br /> Screening Method Vw ' <br /> Tracking Sheet y)/ n ) "x' <br /> 60 - 6d ft- <br /> SPOILS <br /> Storage Method s MATERIM§MEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Ok -S u. Casing type <br /> Blank (11 ft. Screen h. <br /> Slot size a i <br /> GROUTING - Bags cement <br /> Buckets bentonite <br /> Depth to tivater `7 r ( Bags sand/gravel <br /> Mix Ratios_f/l� Cr...xS a o Filter Pack type/size "v <br /> Installation Method Surge Block: - ( n ) <br /> Quantity Installed_ - 2 zwS Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 a, <br /> I <br />