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MONITORING WELL INSTALLATION REPO <br /> r a <br /> Date: °Z4 Q ;. ,. :r : I�1 € . E <br /> .CONSTRUCTION <br /> Premise Address: 6 �L .S ib- x _ , Total Depth 6 o # h <br /> E;- <br /> Well No.: � I� screen Length (from) (to <br /> - , :.a Filter Pack ` from 4. <br /> Benronite (from) <br /> Inspector: r4. .. . Grout.. (from): -(to) <br /> i t Drilling rig typeiL CA E <br /> Permit No. -Auger O.D. ley L I.D. 10` <br /> z Completion - Stove pipe/christle box (circle one) <br /> Drilling Company: <br /> Driller: � ..w,. ��.,�.��.�.. <br /> casing <br /> // height j ! <br /> Consultant <br /> '76T- <br /> Geologist <br /> ABOVE-GROUND t <br /> . CONFLETION C>•1f�lSTY-BOX r <br /> COMPLErnON 11!A <br /> SPECIAL PERMIT INFO. Ground Sudact <br /> Distance to sewer line 40 grout i <br /> Domestic well on site - (y ;P <br /> If yes, location and distance - it. <br /> SAMPLINslorodG <br /> o� saClcn <br /> Holding Temperature — <br /> Method - �;� '` y�raYs!pack <br /> Screening Method a �� <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method r. IV 1ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location T .- �':" Casing e <br /> T <br /> Blank ft. 'Screen „-7 d- ft. f <br /> ,. �. Slot size KD <br /> GROUTING <br /> .Bags cement <br /> t' <br /> :.Q Buckets bentonite � <br /> Depth to water - Bags sand/gravel T/Z :. .. <br /> Mix RatiosC'B.�x- / w ...;Filter Pack type/size <br /> Installation Method Surge Block• - (y <br /> Quantity Installed :- <- -- Discussed with geologist: - (y/ n.) <br /> EH'29 29 'I�rpe of method <br /> ➢ M w <br /> + <br /> t <br />