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t. ONITORING WELL INSTALLATION REP� <br /> Date: - <br /> CONSTRUCTION <br /> Premise Address:_ PQ('�(.�1.0 Total Depth 69E>' <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 591 (to) � <br /> Bentonite (from) -2;z) —(to) <br /> Inspector: A A Grout (from)_Z B (to) <br /> Drilling rig type 1 <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> If Drilling Company: <br /> Driller: (.Pa <br /> casing <br /> height <br /> Consultant <br /> r <br /> - i <br /> Geologist C„D�'1C _eAQ <br /> Ai&E-GROUND <br /> COMPLETION CHR STY-80x <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface 0 <br /> Distance to sewer line Iy�11 sa� �lh `1 �grout� G_ <br /> Domestic well on site - (y/ n <br /> If yes, location and.distance - <br /> -30 <br /> 40 2 .ri.ft. ft <br /> 12 <br /> C V(� <br /> SAMPLING 630 SArn�1(o FJC] aUC�� o S <br /> ,tined <br /> aac',ion SCA n4 <br /> Holding Temperature a'CU cam- <br /> VavW pack <br /> Method UZ (dA [CQ ____ h� Part <br /> ScreeningqCVAfZ— <br /> Method _C lG <br /> Tracking Sheet - n ) y�r F` <br /> SPOILS 1�l <br /> Storage Method 9VL t LSD MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) '! <br /> Storage Location l h SIGH C6yY\ W 0 Casing type 2 Y C SC Vl~ <br /> Blank 73�6 ft. Screen <br /> Slot size . 02-0 <br /> GROUTING <br /> OZ- <br /> GROUTING Bags cement <br /> Buckets bentonite )- 60 <br /> ' Depth to water �" Bags sand/gravel _ IaU <br /> Mix Ratios 101W Filter Pack type/size <br /> Installation Method jp, Surge Block: - (y/ <br /> &:�i <br /> Quantity installed Discussed with geol gist: - tkjCLtW0(',_/ n) <br /> Type of method �"yaq <br /> EH 29 29 5 k6 �D LCLb AVS 5 GS <br />