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eON1TORING WELL INSTALLATION REPO <br />Date: <br />5,21- 0 Jf <br />p <br />Premise Address: .71 e <br />Well No. <br />(to) 1 F <br />Inspector: <br />Zi"r <br />Permit No. <br />Q �� <br />Drilling Company: <br />Cn <br />Driller: <br />�3 —471+0 <br />Consultant_ <br />LD.__ <br />___ _ .. . <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature 90 C- <br />Method &&t -v, 7s !eTip jb <br />Screening Method 0-J7 <br />Tracking Sheet -6 n <br />SPOILS <br />Storage Method <br />Contamination Noted - ( y / n ) <br />Storage Location <br />)GROUTING <br />Depth to water = D l <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />EH 29 29 <br />CONSTRUCTION <br />Total Depth 3!5 <br />Screen Length (from) <br />35 <br />(to) 30 <br />Filter Pack (from) <br />15 <br />(to) 1 F <br />Bentonite -(from) <br />Zi"r <br />(to) ZG <br />Grout (from) <br />Zra <br />(to) o <br />Drilling rig type <br />�3 —471+0 <br />Auger O.D. S <br />LD.__ <br />___ _ .. . <br />Completion - Stove pipe/christie box (circle one) <br />casing <br />T7 T height <br />PTA <br />i1m, <br />ABOVE -GA OUND <br />OOPPL-E TION <br />3o it <br />slatted <br />on <br />Ground Surface <br />�Wr <br />firrNO <br />-_ZVI•. <br />MATERIALS/DEVELOPMENT <br />ft. <br />Casing type Z'`Sck -6 PVe- <br />Blank ft. Screen ft. <br />Slot size '020" <br />_ <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size 30 <br />Surge Block. - (Vn J <br />Discussed with geologist: - ( y <br />Type of method <br />