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%...ONITORING WELL INSTALLATION REP00.,3' <br /> Date:.. // CONSTRUCTION <br /> Premise Address: 1j , f Total Depth / vto <br /> Screen Length (from) q2/- 90' <br /> Well No.: SV E l S �— Filter Pack (from) 9.5T SS• g Z2 <br /> Bentonite ) M d 56-5� <br /> Inspector. YYI�o�I17 7 �p"Lc� Grout (from) SZ-7�. <br /> Permit No. <br /> ��7 7 ( / AugDriller O.D. type— /1-& D <br /> Drilling e <br /> � n p Completion - Stove pipe/christie box (circle one) <br /> UU Cl/ <br /> Company.- <br /> �.P_tt� Fix-�'�^�, <br /> Driller: casing <br /> 7_ height <br /> Consultant Cv <br /> Geologist <br /> ABOVE-GROUND CiifitSrY BOX <br /> COMPLETION COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surtacs <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n 1 ft. <br /> If yes, location and distant - ft. <br /> ft. _ <br /> SAMPLING dot:ad = <br /> V <br /> N soricn F - 2 <br /> Holding Temperature f t <br /> Method = <br /> Screening Method P1/) = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS c � PV <br /> I y It JV" <br /> Storage Method SSS MATERIALS EVEI.OPMENT lot, " _Q�+` <br /> Contamination Noted - y npnq� <br /> Storage Location Casing type o <br /> Blank ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> pvc- <br />