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100NITORING WELL INSTALLATION REPO <br /> Date: Z�` ° CONSTRUCTION <br /> Premise Address: Z3-� �^N y c� Total Depth <br /> Well No.: -tin /, Screen Length (from) (to) $4 <br /> Filter Pack (from) 65- (to) $ <br /> ��"" ` Bentonite (from)A_(to) 9 <br /> Inspector: _ �(aw+( �fcrue O c Grout (from) L1 L (to) iJ <br /> Drilling rig type TI- -- <br /> Permit No. Auger O.D.—" D <br /> Completion - Stove piped stie box (circa yne) <br /> y <br /> Drilling Company: (r fcS <br /> Driller: 4 l F�v�g �(evr t t�Ie (� T casing <br /> height <br /> Consultant Ii(iVh t - <br /> Geologist >of f w ✓l� _ <br /> ABOVE-GROUND <br /> CONFLEfION CHR ITY-BOX <br /> SPECIAL PERMIT INFO. G=nd Sax <br /> fe COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> q <br /> - O <br /> SAMPLING — o <br /> slotted _ 8 <br /> soc9an — <br /> Holding Temperature <br /> Method — vaW pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type '6�* Q U i_ <br /> Blank SJ ft. Screen t a <br /> ft. <br /> Slot size <br /> GROUTING Bags cement ( p">at S <br /> - Buckets bentonite 1�A <br /> Depth to water _ Bags sand/gravel_ okba. S <br /> Mix Ratios 6A S Filter Pack type/size b 75 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />