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OONITORING WELL INSTALLATION REP* <br /> Date: /V �O —�O CONSTRUCTION <br /> Premise Address: 5coz� to P-la Total Depth St7(2 w 6 <br /> Tt:.r, J.oz.S Screen Length (from) i (to) Co <br /> Well No.: Filter Pack (from) 5 (to) <br /> Bentonite (from) Yq yr--(to) 2 <br /> Inspector: Grout (from) Z (to) <br /> ^ ��9 Drilling rig type Gt�+-b Zr <br /> Permit No. 0.� 1J Auger O.D. I.D. 4 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: ng <br /> �� A IV / „ <br /> OjV),Yheiht <br /> Consultant ((�L�/'`GeologistROC iMM-Box <br /> ET COMPLETION <br /> SPECIAL PERMIT INFO. Ground S�i09 T� <br /> Distance to sewer line 56 grout <br /> Domestic well on site - (YO 7 n, <br /> If yes, location and distance - Z ft. <br /> = m <br /> — e <br /> = o <br /> — c <br /> SAMPLING slotted = <br /> ^ section '= <br /> Holding Temperature gravel pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> tt, tt. <br /> SPOILS � <br /> Storage Method Gr `� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y(2!)) Z k S� <br /> Storage-beeetien Casing type <br /> Blank G' 7 ft. Screen /U ft- <br /> slot size .02Z) <br /> GROUTING Bags cement <br /> Buckets bentonite O'er 3U <br /> _ <br /> Depth to water — Z Bags sand/gravel SU <br /> Mix Ratios — Filter Pack type ' e <br /> Installationt <br /> tho Surge Block: - (y/Quanrity Iled Discussed with geologist: - y n ) <br /> Type of method <br /> EH 29 29 // <br />