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WITORING WELL INSTALLATION REPO <br /> Date: I l I CONSTRUCTION <br /> Premise Address: S ��h Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) 1-7 <br /> Bentonite (from) 17 (to) 5 <br /> Inspector.` Grout (fro t) S (to) c c e� <br /> Drilling rig type a 1 Pb:> r c nteu� <br /> Permit No. Auger O.D. I.D. <br /> r _ �� Compledot� Stove pj cluistie box (circle one) <br /> Drilling Company: �! ��.� <br /> Driller: casing <br /> height <br /> I <br /> JT <br /> Consultant !� Q� 7� p �- ��,/J I���) -i- <br /> Geologist <br /> ABOVE-GRCUND CHR*Iry-8CX <br /> COWLETICN CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground sudaa <br /> Distance to sewer line r Orad <br /> Domestic well on site • g, <br /> If yes, location and distank(y n )7 n, <br /> O <br /> SAMPLING BnP qac ° e CD abratl :M: <br /> sacticn <• __ <br /> Holding Temperature = gr,v.I pack <br /> Method m_.e �m K/,-� <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) r `s; = <br /> �n. "• = 3 to <br /> SPOILS (� <br /> Storage Method MATERIALS/DMI.OPMENT <br /> Contamination Noted . y n p <br /> Storage Location Casing type I <br /> Blank ��' ft. Screen f,.5 ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / I Buckets bentonite I <br /> Depth to water a / Bags sand/gravel <br /> Mix Ratios Filter Pack type/size m <br /> Installation Method b Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 912,2,1?/ �3 <br />