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...JNITORING WELL INSTALLATION REPO. <br /> Date: �(� ` V9 �) CONSTRUCTION <br /> C�LIJ Vy C l _ r ' <br /> Premise Address: UVA y Total Depth <br /> n Screen Length (from) S (to) <br /> Well No.: �� 1 W U Filter Pack (from) '36 __(to) 7.0 <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type bw <br /> Permit No. 3 ' Auger O.D. �/1 I.D. 'f <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: l�� <br /> Driller: USS S v �YStY� casing <br /> he, <br /> Consultant 7 ' <br /> lG1711T" <br /> Geologist �• T' <br /> ABOVE-GROUND CNASSTY480X <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. �/�r n 1 U Ground Surface <br /> Distance to sewer line 1- ►V grout <br /> Domestic well on site - (y/ n) <br /> ft. <br /> If yes, location and distance - f <br /> Will YIO'+ V-V- YJr-) <br /> SAMPLING 30r GOiCe c` '-���7vIGOIJ�►-{C/�Q� _ o <br /> tIOC.od <br /> r � socdcn -„ — <br /> Holding Temperature C -c UG- <br /> Method OY i-5 t : _ F <br /> Screening Method I r^ — <br /> Tracking Sheet - UY7n ) <br /> J ft. � = ft. <br /> SPOILS <br /> I,/ ,, <br /> Storage Method l5f� ilk MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - (y/ n ) 2-ir �V� <br /> Storage Location I Casing type <br /> Blank 2. ft. Screen <br /> IJK Slot size . 0 7 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water O Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/—11-) <br /> Quantity Installed Discussed with geo gist: - n) <br /> Type of method <br /> EH 29 29 <br />