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MONITORING WELL INSTALLATION REPOA , <br /> r <br /> Date: � " I �� CONSTRUCTION <br /> Premise Address : ,W-7Ye 7 AJ Pc+ptnt`° Total Depth 15 " " " 6 '/ <br /> / Screen Length (from) (to) 57 <br /> Well No. : / Filter Pack (from) 72 Q (to) 557V <br /> Bentonite (from) SS (to) 5L9- <br /> Inspector: Grout (from) 52 —(to) n <br /> �q Drilling rig type f�D - 74A. A <br /> Permit No. ��J ( L Auger O.D. g I.D. 4 <br /> P <br /> Drilling Completion - Stove pipe/christie box (circle one) <br /> Company: - (-91.f� <br /> Driller: �` casing <br /> height <br /> Consultant 4c4r� <br /> Geologist ` - <br /> ZIABOVE•GROUNO <br /> CtIAJSTY-BOX <br /> i 9 COMPLETION OMPLETION <br /> SPECIAL PERMIT INFO, Ground Surtxe <br /> Distance to sewer line <S v - - - grout <br /> Domestic well on site - ( y n 5yZf <br /> If yes, location and distance - /�/L"'�1� �k�"— �' <br /> Rw ft. <br /> f = <br /> a <br /> SAMPLINGt <br /> ❑otted � <br /> &*don <br /> Holding Temperature <br /> Method = <br /> Screening Method = " <br /> Tracking Sheet - ( y / n ) 1z <br /> SPOILS 75 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) A � "' f� <br /> Storage Location Casing type Z " nuc (ti - ru J <br /> Blank 57 ft. Screen 15 ft. <br /> Slot size oto" <br /> GROUTING Bags cement itu <br /> Buckets bentonite - 7X30 IN " <br /> Depth to water Bags sand/gravel 00 rk <br /> Mix Ratios ZS' Qa.P.c t 4 (>a4a (nJq Filter Pack type/size 0 9 <br /> Installation Method Surge Block: - ( y fni <br /> Quantity Installed ICXD [ Discussed with geo` ogist: - ( y n ) <br /> Type of method <br /> EH 29 29 <br /> Cos <br />