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MONITORING WELL INSTALLATION R.EPORTIO' <br /> Date: `T -c CONSTRUCTION <br /> Premise Address: 3 ooh Total Depth 3D <br /> ' Screen Length (from) e tl (to) 3� <br /> Well No.: /�h .y'9- to Filter Pack (from) v (to) <br /> Bentonite (from) 8 (to) <br /> Inspector. Grout (from) (to)_ 1-e <br /> Drilling rig type 1 -.3 <br /> Permit No. Auger O.D. f O G I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. <br /> Driller: <br /> hezg <br /> Consultant <br /> Geologist" G �. <br /> A3C VE-G rqC JNO cr�isrr-aox ' <br /> C4hVlr�T10N COMPL ETICN <br /> SPECIAL PERMIT INFO. Cxrund Sulks �-`-"--'--° <br /> Qrout <br /> Distance to sewer line 1 <br /> Domestic well on site - ( y/ n ) 7 - ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> r <br /> C <br /> O <br /> SAMPLING &ioroi <br /> sacfcn = - <br /> Holding Temperature vd <br /> Method _ s <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method ° SM ,Q/ MATERIALSIDEVELOPMENT <br /> Contamination Noted - (y/ n ) �— �� ��� <br /> Storage Location Casing type -- <br /> Blank fL Screen h. <br /> Slot size o�� <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Depth to water_ - ^ ) Li Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Z/� — <br /> Installation Method Surge Block: - ((may n ) <br /> Quantity Installed Discussed with geologist: - (y/ n } <br /> Type of method <br /> EH 29 29 <br />