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�- NIONITORING WELL INSTALLATION REPO°:' <br /> Date: I I 1'I CONSTRUCTION <br /> Premise Address:_ '$� l:_ IAAk,;, k Total Depth <br /> '�/ K—p " Screen Length (from) <br /> Well No.: t.�J Y 'r` / Filter Pack (from) I-t;r (to) <br /> Bentonite (from) S (to) <br /> InsP ector: s j2 <br /> Grout (from) 3 to) J <br /> t4 Drilling rig type <br /> Permit No. S t"t/ �• 3�-� Auger O.D. o " I.D. <br /> Drilling Company:_ Completion - Stove pipe/christie box (circle one) <br /> . U �w ��"W� <br /> Driller: ��rGt1�v casing <br /> height <br /> Consultant •� ' <br /> Geologist <br /> ABOVEGROUND <br /> COM?LETION 15TY <br /> SPECIAL PERMIT INFO. Ground Suaixw COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site y/ n ) - + <br /> If yes, location distance - ft. <br /> + "S ft. <br /> .`t. <br /> C <br /> SAMPLING slotted _ <br /> Becton <br /> Holding Temperature <br /> Method _ P <br /> Screening Method '= _. <br /> Tracking Sheet - (y/ n ) <br /> 7 �n. _ ft. <br /> SPOILS I <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n )A ' if <br /> Storage Location tA, S✓`�- Casing type P V(i <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement LZ 0%"Yk <br /> Buckets bentonite <br /> Depth to water ''f S 5 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method w•,- -Z. Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> �� � - <br />