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'M6NITORING WELL INSTALLATION REPO".. <br /> Date: �J' �'7 CONSTRUCTION <br /> Premise Address: Q� ��'�- ( Total Depth �t7 <br /> Screen Length (from) -(to)�_ , <br /> Well No.: M Filter Pack (from) (to) <br /> Bentonite (from) <br /> C�7-�c�� (to) <br /> Inspector: Grout (from) (to). --4�-- <br /> r,, Drilling rig type <br /> Permit No. , . 034 Auger O.D. Z Z�— <br /> Completion - Stove pip cluist'e box circle one) <br /> Drilling Company. <br /> Driller: <br /> casf.ng <br /> • � <br /> height <br /> Consultant ' <br /> Geologist Mc�- <br /> ABOVE-GRCUND C.HRM Y-BOX <br /> CONFLEMN CQMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line l gf0ut <br /> Domestic well on site - (y/ n) It. <br /> If yes, location and dist�nc fL <br /> SAMPLING riara� — C <br /> n sedcn _ 3 <br /> Holding Temperature = F <br /> ack <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - Qq n ) - <br /> SPOILS <br /> Storage Method l9pi Lcimz MATERIALS/DEVELOPMENT <br /> Contamination Noted • (y/ <br /> Storage Location Casing type g� ��- <br /> Blank ft. Screen ft. <br /> Slot size Oe 0/0 <br /> GROUTING Bags cement (sZ,v <br /> Buckets bentonite / 13t-cco f— <br /> Depth to water f Bags sand/gravel <br /> Mix Ratios /Q -wzrut- Otic � Filter Pack type/size I� <br /> Installation Method Surge Block: - ( y 417 <br /> Quantity Installed Discussed with geologist: -OYn) <br /> Type of method <br /> EH 29 29 �" <br />