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Iv ONITORING WELL INSTALLATION REPO& <br /> i <br /> Date:_ /3��0 6 nAl CONSTRUCTION <br /> Premise Address: &W A7 Total Depth rPd <br /> p Screen Length (from) (to) <br /> � <br /> Well No.: �� d Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) W (to) O <br /> .r Drilling rig type <br /> Permit No. ® � Z2SL �t e w .► iF Auger O.D. R I.D. <br /> Drilling Company:_ <br /> Completion - Stove pipe/christie box (circle one) <br /> cz.o�.Q <br /> Driller: — C casing <br /> height <br /> Consultant n <br /> Geologisty <br /> ABOVE-GROUND CHAISTY-BOX <br /> COMPLETJON COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAacs %7 <br /> Distance to sewer line ^< 50 ' � grout <br /> �J <br /> Domestic well on site - (y 7 s3/, <br /> If yes, location and distance - ft' <br /> n. 39 <br /> m <br /> - � m <br /> - m <br /> C <br /> SAMPLING slotted <br /> socton <br /> Holding Temperature l <br /> Method &4; o : _ pa,* <br /> Screening Method ; <br /> Tracking Sheet - ( y/ n ) �q <br /> Fft. _ $. <br /> SPOILS W <br /> Storage Method /yl 41-4 -/ MATERIALS/DEVELOPMENT <br /> Contamination Not - (y� <br /> Storage Location . Casing type <br /> Blank ft. Screen 20 ft. <br /> Slot size D 10 <br /> GROUTING Bags cement /00 OCH <br /> Buckets bentonite <br /> Depth to water 7f Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Z I y <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 / <br /> 6A /tLuJ 7 �eLt <br /> .S/3 /2-oo(P �' <br />