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vlONITDRING WELL INSTALLATION REI T <br /> Date: k 211 L. CONSTRUCTION <br /> Premise Address: S- Total Depth <br /> Screen Length (from) (to) <br /> Well No'.. �� 4Zr Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ _ <br /> Driller: casing <br /> he; <br /> Consultant n ' ' —WWT_ <br /> Geologist _ •-- <br /> /IBCVE-GRCUND C4-lRz7y-80X <br /> CO Mie L._Rf0 N <br /> COMPL EMCN <br /> SPECIAL PERMIT INFO. Grund Sulac* <br /> Distance to server lino-4— <br /> grout <br /> Domestic well on site - ( y ) ft <br /> If yes, location and distance - ft <br /> ft. <br /> C <br /> 0 <br /> SAMPLING elored = <br /> &*cion '- <br /> Holding Temperature VXVW— <br /> Method (/0,4r /�/0rkL4 ` <br /> --r — <br /> Screening Method <br /> Tracking Sheet - 00 n ) <br /> _ft. — —ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location _ Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 20 -2-t �� Bags sand/gravel <br /> Mix Ratios __ Filter Pack type/size <br /> Installation Method _ Surge Block: - ( y/ n ) <br /> Quantity Installed _ Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> Eli 29 29 <br />