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%..,JNITORING wEU INSTALLATION REPO,,,/ <br /> Date: ;-, 7 ACONSTRUCTION <br /> Premise Address: L G9c�� Total Depth <br /> ,,/ Screen Length (from) 9 S" (to) <br /> Well No.• <br /> / 4V •�/(/ Filter Pack (from) �S` (to) <br /> Bentonite (from) 3 (to) f' <br /> Inspector: Grout (from)-7- (to UA 4, a- <br /> Drilling rig type 61 <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant La�� <br /> Geologist <br /> ABOVE-GROUND CH RZ7Y-)OX <br /> CONFL.EfION COMPLETION <br /> SPECIAL PERMIT INFO Gmurd Surlaca - <br /> Distance to sewer line flan <br /> Domestic well on site - y n) �it< <br /> If yes, location an dis ce - ft- <br /> m <br /> ..z• C <br /> _ Q <br /> SAMPLING slora i y — <br /> d� sacicn <br /> Holding Temperature 9 Pack <br /> Method /5-e <br /> Screenin;Method 777) _ — <br /> Tracking Sheet y n <br /> SPOILS <br /> Storage Method cVk- MATERIALS/DEVELOPMENT <br /> Contamination Noted - { y <br /> Storage Locations.s Casing type <br /> Blank ft. Screen <br /> Slot size .010 <br /> GROUTING Bags cement <br /> Buckets bentonite l <br /> Depth to water 'i4 Bags sand/grave! <br /> Mix Ratios Filter Pack type/size z /T <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: yep n ) <br /> Type of method <br /> EH 29 29 <br />