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1IONITORING WELL INSTALLATION REPO <br /> Date: �P /p 201 CONSTRUCTION <br /> Premise AddressSSO `� F Total Depth_ <br /> Screen Length (from) (to)_y` <br /> Well No.: �/ y Filter Pack (from) (to) 77 <br /> Bentonite (from) (to) 11 D <br /> Inspector: Grout (from) (to) <br /> Drillin rig type <br /> Permit No. 6 2 D(G 2, C er O D. I.D. <br /> Comple Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casin <br /> �_ 3 height <br /> Consultant l.� <br /> Geologist �� ����� <br /> �VEGfi0UN0 CHRISTY-BOX <br /> 5 MPLE7b COMPLETION <br /> SPECIAL PERMIT INFO. / Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - n ) Z n, <br /> If yes, location and distance- 35 33, ft- <br /> 7-1 <br /> m <br /> SAMPLING slatted <br /> section <br /> Holding Temperature_ L�j , �j f = gavel pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) 9 u <br /> SPOILS \\ <br /> Storage Method ��� 3��frr MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ,t <br /> Storage Location / Casing type 7i <br /> 31ank 3�fr. Screen t0 ft. <br /> Slot size 074" <br /> GROUTING Sags cement <br /> Wckets bentonite 1 t +� <br /> Depth to water lags sand/gravel 5615 rs <br /> Mix Ratios Filter Pack type/size 'f <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: <br /> Type of method <br /> EH 29 29 <br />