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-WIONITORING WELL INSTALLAIL ION REPOnI' <br /> Date:—O— V t^ CONSTRUCTION <br /> Premise Address: Total Depth Z� <br /> Screen Length (from) t$. (to) 13-5 <br /> Well No.: Filter Pack (from) 25 (to) <br /> Bentonite (from)!0-3 (to) <br /> Inspector: Grout (from) (to) b <br /> F �! Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. <br /> awl <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:. <br /> Driller: ti�(t '�� r #ABtCVE-4G3RC0)UN0 <br /> )igh <br /> IHI <br /> Consultant ,/�2 ��" <br /> Geologist / QNB <br /> CF67ISTY-80X <br /> WP <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf'n <br /> 7 grout <br /> Distance to sewer line <br /> Domestic well on site - (y I n ) 2 Q tt <br /> If yes, location and distance - —� ttft. <br /> — a <br /> m <br /> m <br /> - m <br /> C <br /> SAMPLING slottsd = {' <br /> amcton — -- <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) Z LS <br /> tt. tt. <br /> SPOILS <br /> Storage Method Lc3 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) err Ty C <br /> Storage Location Casing type �T <br /> Blank 13.5 ft. Screen r <br /> Slot size . O'er 'r <br /> GROUTING Bags cement 3'z - 4y a-ea <br /> Buckets bentonite 't a-y z <br /> Depth to water �S Bags sand/gravel --7 <br /> Mix Ratios 'r Filter Pack type/size 03 <br /> Installation Metriod Surge Block: - (y/ n ) <br /> Quantity installed 37z = 56Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 -7q <br /> 4(-rO� <br />