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.JNITORING WELL INSTALLATION REPOh . <br /> i, <br /> Date : N \ � �r 1 CONSTRUCTION <br /> Premise Address : 1 o � C ( Yalr Total Depth � 0 ' <br /> - n , / Screen Length (from) Ao (to) M <br /> Well No. : W lrI Filter Pack (from) 0� L? (to) ( a <br /> Bentonite (from)74,,7—, (to) L L <br /> Inspector: Ii; rC"t Grout (from) tle (to) n <br /> Drilling rig type <br /> Permit No. 7 C1i [ , OOi Auger O.D. q LD. <br /> DrillingCompany: <br /> n p Coto k � Completion - Stove pipe/christie box (circle one) <br /> � � t�V-�" �-- <br /> Driller: ---��� casing <br /> height <br /> Consultant_�n , �! <br /> Geologist u i S W. T <br /> ABOVE-GROUND <br /> COMPLETION CHfl STY BOX <br /> SPECIAL PERMIT INFO. G=nd Swiace COMPLETION <br /> Din1ocati <br /> l ne "Out <br /> Dsite y / n ) <br /> If distance - ft• <br /> ft n. <br /> SAMPLING — <br /> Blotted L. <br /> axion <br /> Holding Temperature = P <br /> Method Luh tgavol <br /> Screening Method ? <br /> Tracking Sheet - ( y / nbC1) <br /> ft. = tt. <br /> SPOILS <br /> Storage Method_ S v>r-"A7 MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location l+ S Casing type J ftS (. 4 d0 fU Z <br /> S Blank -r . Screen zv` ft. <br /> Slot size <br /> GROUTING Bags cement (L <br /> Buckets bentonite <br /> Depth to water_ ( Bags sand/gravel <br /> Mix Ratios 1,7 ,x;4 Filter Pack type/size <br /> Installation Method Surge Block: - n ) <br /> Quantity Installed ( P7 &VW Discussed with geologist: - (�/ n ) <br /> Type of method <br /> EH 29 29 <br />