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- � 1 - <br /> -..JNITORING WELL INSTALLATION REPOh <br /> M -- <br /> Date : G l <br /> CONSTRUCTION � � $ 5 • l y ty�,,a�l�� <br /> Premise Address: [ % of l: ( InO O Total Depth SO <br /> Well No. : <br /> w'�V Screen Length (from) R __u , (to) I <br /> Filter Pack (from) (to) 3 <br /> Inspector: � Swt./ "tAA'', Cr ' ( pf� t Bentonite (from).(to) <br /> Grout (from) IW -1 (to) [0 <br /> byDrilling rig type Caen 1 S <br /> Permit No. 5 (G �(�J Auger O.D. $ "t I.D. <br /> Drilling Company: <br /> AvI w . / /�'�l_ e)Completion - Stove pipe/christie box (circle on- <br /> Driller: SW�✓\� <br /> casing <br /> height <br /> Consultant 41 r ! <br /> � <br /> Geologist �� / <br /> ABOVE-GROUND <br /> COMPLETION & <br /> SPECIAL PERMIT INFO, G=nd Surlacy <br /> COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on si - y / n <br /> If yes, location di R. <br /> I�C570 n. f<. <br /> SAMPLING o <br /> dotted = S <br /> wcion — <br /> HoldingTemperatur <br /> Methodvivo( Pack <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method SS PuAw4w7 MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location 4 �c Casing type Qb Sinn. ? UL <br /> S c4y0c6lr rBlank � ft. Screen ' S ft. <br /> Slot size 00 01 <br /> GROUTING Bags cement \ b <br /> Buckets bentonite 1 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size _Z01Lr <br /> Installation Method • P� Surge Block: - / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />