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MONITORING WELL INSTALLATION REPOA L <br /> Date 26-x7 ZD//, CONSTRUCTION <br /> Premise Ad ess; -- Total Depth A <br /> Screen Length (from)--j (to) (o <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Y- <br /> Inspector: Grout (from)�(to) 2 <br /> Drilling rig type C <br /> Permit No. `, a(n zea 0'Y Auger O.D. I.D. 7 Z <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> (��, <br /> Driller: --f / Sall1�T fi / casing <br /> eight <br /> Consultant -EW-F <br /> Geologist Ae O Qr'^x"" AE&E-GROUN <br /> CHAISTY-80X <br /> 00 <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground S <br /> J✓/� Grout <br /> Distance to sewer line � / <br /> Domestic well on site -C% n ) �`� ft. <br /> If yes, location and distance - t!3 ft ft. <br /> (7 — a <br /> — m <br /> = n <br /> �7g &lotedSAMPLING /- sacon <br /> Holding Temperature Lp^ <br /> Gra,rel pack <br /> Methodr&t� <br /> Screening Method <br /> Tracking Sheet - y n ) _ <br /> SPOILS <br /> Storage Method 7 -d3 5 J S/DEVELOPMENT <br /> Contamination Notet- yin / Z If C 4p �j(C1 <br /> Storage Location (� �,_ (. /Sr0 �,S pe Screen V <br /> Screenh_fr• <br /> GROUTING v�t lent Qt OZO <br /> al/ cilOP/� bentonite <br /> Depth to water d/gravel <br /> I <br /> Mix Ratios 14tC- 5 -I — ck type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity installed� Discussed with geo ogtst: - (y/ n) <br /> Type of method <br /> EH 29 29 <br /> 13C <br />