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BYO <br /> 3 OONITORING WELL INSTALLATION REP �� <br /> iW� �al.o <br /> yq7.o/p <br /> Date: CONSTRUCTION <br /> CONSTRUCTION <br /> Premise Address: <br /> �4��6 S �d �� v– Total Depth I0 <br /> Screen Length (from) (to) <br /> Well No.: b� Filter Pack (from) (to) <br /> 14 <br /> //,, n Bentonite (from) (to) <br /> Inspector: n� U Grout (from) (to) <br /> Drilling rig typeW111 AeG-10-t� <br /> Permit No. R f Auger O.D. 5f T.D. A/ <br /> Drilling Company. � � Completion - Stove pipe/chisue box (circle one) <br /> 17 <br /> Driller: / ;a< < casing <br /> height <br /> Consultant IV <br /> Geologist�n <br /> i /ABP-GIR'NND <br /> CHA7M-BCX <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. ` Grourd gL�Tlxy <br /> Distance to sewer line A grout <br /> Domestic well on site - / n) iL <br /> If yes, location and dis ince - <br /> — m <br /> SAMPLING <br /> Cloned — S <br /> •coon <br /> Holding Temperature s = h L r <br /> Method <br /> Screening Method `c <br /> Tracking Sheet • ( y/ n )_ — <br /> tt. _ 0 ft. <br /> SPOILS <br /> Storage Method_ MATERIALS/DEVELOPMENT <br /> Contamination Noted . (y <br /> Storage Location K71 S OfP Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> � Buckets bentonite <br /> Depth to wate� �S ��Z 3 t t3 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method t�tC. Surge Block: . ( y/ n f <br /> QuantityInstalled � Discussed with gelog (y/ n ) <br /> EH 29 29 Type of method <br /> Pte' <br /> 93 /) °�L <br />