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- S <br /> YO-NITORING WELL INSTALLATION REPO _ r <br /> -�' �'`a fix'•T'�i g, �.� —'. , •� Y <br /> Date: I � % CONSTRUCTION �^�: �• ��` . ^.� A - � <br /> Premise Address: D l✓ ��C4 ^' ' n: r j '] Total Depth <br /> Screen Length (from) (to) <br /> Well No. 1 T�Rilter Pack (from) (to) <br /> Bentonite (from) (to) f ' <br /> Inspector:' ' . _ .. Grout. (from) (to) <br /> z Drilling rig type <br /> �. �•,r ak I.D. <br /> `Permit Nod .w SO _ Auger O.D. <br /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: .,. , <br /> ® <br /> casin <br /> Driller: WY'1c"it <br /> he;ght <br /> Consultant 1,4, fes` <br /> Geologist <br /> ABOVE-GACCMD GHFit.STY-SOX <br /> ..xGOWLETCNr- COMPLEnON <br /> SPECIAL PERMIT INFO. Ground SjAfwt <br /> t Distance to sewer line grout <br /> Domestic well on site - (y/ n) " " s C - 4 <br /> If yes, Iocation and-distance - <br /> W' <br /> m <br /> b <br />'F SAMPLINGsocicn <br /> r <br /> Holding Temperature _ � . <br /> Method k <br /> Screening Method <br /> 17 <br /> Tracking Sheet - (y/ n ) <br /> SPOILS } <br /> Storage Method t' g. :" ; A!IAT> RIALS/DEVELOPMENT. , n <br /> Contamination Noted - (y/n <br /> Storage Location Casing type <br /> d t Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement 2 <br /> i 4 <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 . .- b- Discussed with geologist:.• (y/ n) <br /> Type of method <br /> EH 29 29 <br />