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iv10NITORING WELL INSTALLATION REPOni <br /> Date <br /> Z7 20 r r CONSTRUCTION <br /> di+-w l Depth �Z 6 <br /> Premise Address: Tota / S (to) <br /> ,, Screen Length (from) <br /> Well No.: 14// � Filter Pack (from) /Z(c (to) /0 <br /> Bentonite (from) /0 8 (to) /0 3 <br /> Inspector• Grout (from) /off (to) 712— <br /> Drilling rig type A�7 C- <br /> Permit No. -5W,062(P62 Auger O.D. •s;� LD. <br /> /� � �� Completion - Stove pipe/christie box (circle one) <br /> Drilling Co/mpany: �-Caibc! <br /> Driller:`,/ "f � � casing <br /> height <br /> Consultant G)qA <br /> Geologist—A6 q�lRlp aGrourd <br /> COMPLEMON <br /> GOMPLE>•ION <br /> SPECIAL PERMIT INFO. / Surface <br /> Distance to sewer line <br /> NIA A ^ grout <br /> Domestic well on site - (y/n) /6 3 ft. <br /> If yes, location and distance - 6F It, <br /> /!6 ft. <: <br /> 7-27 7/2? <br /> 0 <br /> SAMPLING <br /> sac�on <br /> Holding Temperature gra e1 p3dK <br /> Method y !� <br /> Screening Method <br /> Tracking Sheet - (y/ n) ,Ott) <br /> SPOILS 5 '47 <br /> Storage Method /� �j ATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) ^ �� <br /> Storage Location !/l/ <br /> (r ing type <br /> / Ca <br /> � ft <br /> nk ftp!/y . Screen h. <br /> !6-* of size OZO <br /> GROUTING igs ce7tentonite <br /> ickets <br /> Depth to water �y B-ags sanMix Ratios t 3�{0 Filter Paize <br /> Installation Method �^ Surge Block: - (y n <br /> Quantity Installed '0 t Sot SU Discussed with geo ogist: - (yn) <br /> Type of method <br /> EH 29 29 <br /> eZ14 27 <br />