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�KIONITORING WELL INSTALLATION REP(,4ef <br /> 1 <br /> Date: v�►� 3� a� CONSTRUCTION <br /> Premise Address: 31bt) �r Total Depth <br /> Screen Length (from) 3D (to) 15 <br /> Well No.: or Filter Pack (from)—_(to)Z60 <br /> Bentonite (from) // (to) 76, <br /> Inspector: /A` Grout (from) (to) O <br /> Drilling rig type U^"-qc� 75 <br /> Permit No. 53d76 Auger O.D. ID I.D. <br /> //� Completion - Stove pipe/christie box (circle one) <br /> Drilling Com®p�an�y: ` (/"ti�i <br /> Driller: r`-oU`uV� �` J� ca) <br /> sin <br /> Consultant TC"'V') 1H.T <br /> Geologist l <br /> ABOVE-GROUND Ci1AISTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. (m+nd Surf <br /> Distance to sewer linegrout <br /> Domestic well on site - ( y/ n) <br /> If yes, location and distance - /y -0 <br /> n. 3 <br /> - <br /> = m <br /> — o <br /> SAMPLING slottod = 8 <br /> axtion — <br /> Holding Temperature <br /> Method Pack <br /> Screening Method =_ " <br /> Tracking Sheet - (y/ n) ,E <br /> 3D <br /> SPOILS n / <br /> Storage Method 12 A'Le -r lAa-a/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type I SA 46 Pye- <br /> Blank /5 ft. Screen !5 ft. <br /> Slot size '02-10 <br /> GROUTING Bags cement 14 <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel +t3 r Z '� 6u <br /> Mix Ratios- V%* Filter Pack type/siz 17 <br /> Installation Meth d Surge Block: - (yn ) <br /> Quantity Installed — D Discussed with geo gist: - ( y4 no <br /> Type of method <br /> EH 29 29 <br /> �j -0 Com71— / l// <br />