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ONITORING WELL INSTALLATION REPO* <br /> Date• <br /> 1 I CONSTRUCTION / <br /> Premise Address: s�5rA1 V�1 Total Depth 3-7 <br /> Screen Length (from) 3 (to) <br /> Well No.: �^ V Filter Pack (from) (to) <br /> �n n _gam Bentonite (from) (to) <br /> Inspector. �JINe/C Grout (from) (to) <br /> Drilling rig me—L. tw nA(-;-w <br /> Permit No.- �� Auger O.D. I.D. <br /> r1Completion ove pip cluistie box (circle one) <br /> Drilling Company: (1, �u ��o�� .�v� �l`r'� . <br /> Driller: casing <br /> Consultant he_ght <br /> . IFL-J-.� <br /> Geologist r o>-') ( ? I L t'6,� _ •- <br /> A80VEGACUND CHRZN-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SW'n <br /> QVT <br /> Distance to sewer line Oran <br /> Domestic well on site - (ytn-j fig _tte <br /> If yes, location and distance F7tt <br /> tt. <br /> Je- <br /> A a <br /> Y.O. <br /> _ C <br /> SAMPLING el-q- ga a. 'c <br /> C�.2� sar+cn <br /> Holding Temperature " = pawl Fadt <br /> Method �ti Ate • Vr c . a' <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <<"�^� ^^^ ,� ' <br /> Storage Method � �%Cl` �G ' MATERIALS/DEVELOPMENT <br /> Contamination Noted J (y/ v <br /> Storage Location Q Casing type <br /> Blankfr. Screen---J--,—ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to <br /> ti water_ Bags sand/gravel_ <br /> Mix Ratios C,e� Filter Pack type/size <br /> Installation Method r Surge Block: - (y/ it ) <br /> Quantity Installed Discussed with geologist: • (y/ n ) <br /> Type of method <br /> EH 29 29 <br />