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1` <br /> MONITORING WELL INSTALLATION REPO <br /> Date: ` 3 CONSTRUCTION w <br /> F <br /> Premise Address: <br /> i 'jE_ 4" Total Depth <br /> j � Screen Length (from) -mss (to) �3S <br /> Well No.: Filter Pack (from) 55 (to) -33 <br /> r Bentonite (from) (to) 31 <br />' Inspector: Grout (from)_ 3I (to)_ a' <br /> Drilling rig type C S <br /> Permit No. Auger O.D. /o` I.D. (d <br /> f J Completion - Stove pipe/christie box (circle one) <br /> f Drilling Company: <br />' <br /> Driller• casing <br /> Ihj � # height � <br /> Consultant T <br /> f T <br /> Geologist _ <br /> s ABOVEGROUND <br /> f k caMP�ioH ca�rsrr-box ; <br /> COMP=ON e <br /> E SPE AL PERMIT INFO. S'� <br /> Il. . <br /> 70. <br /> Distance to sewer line h Qfout <br /> ' � I <br /> Domestic well on site - {y� it. - <br /> If yes, location and E distance - - -"` 3' M <br /> SAMPLING r slotted 1 <br /> sacicn <br /> Holding Temperature <br /> �� trayst pack <br /> f Method K i <br /> Screening Method ISI ~ f r — <br /> Tracking Sheet (`y/ n) <br /> it <br /> 551 tt. `� IE <br /> :. <br /> f SPOILS <br /> Storage Method f MATETUALS EVELOPMENT <br /> Contamination Noted - {y/n ) <br /> Storage location She __ Casin <br /> � g type 7 <br /> V Blank _ 35 ft. Screen � ft. <br /> s; , <br /> Slot size o <br /> GROUTING Bags cement ��-c- <br /> "` , Buckets bentonite <br /> Depth to water - Bags sand/gravel <br /> Mix Ratios Filter Pack type/ 'zee 112 <br /> Installation Method's Surge Block: - OYn ) <br /> Quantity Installed_Of =_3 SS _(_�.^�� �a_ Discussed with geologist: - n ) <br /> {i Type of method ✓t <br /> EH 29 29IT <br /> .2 KCk <br /> _ _ �Q .•• <br /> r � Z <br />