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4RONITORING WELL INSTALLATION REPOK`1' <br /> Date: �/r Z - fill , CONSTRUCTION <br /> � <br /> Premise Address: 0-1✓ Total Depth I n f -Z <br /> // Screen Length (from) T (to)- <br /> Well No.:41 f/) �`f Filter Pack (from) T� (to) 2, <br /> Bentonite (from) Z' (to) <br /> Inspector: Id ��`^' Grout (ho ) I (to) <br /> Drilling rig e <br /> Permit No. �5�`1 Auger O.D. Lf <br /> I.D. <br /> Completion - Stove pi a/christie box (circle one) <br /> Drilling Company: ff L( �Xf LO'1 <br /> Driller: Casing <br /> // height <br /> Consultant (-,,g G <br /> Geologist � - <br /> AiC .GACUND CNR*7Y-80X <br /> CONFL.ETCN CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sumacs + �•� <br /> Distance to sewer line <br /> proof <br /> Domestic well on site - ( y/ n) <br /> If yes, location and distance - <br /> ft. Z' ft. <br /> C <br /> SAMPLING flot-ad <br /> c <br /> soden — <br /> Holding Temperature = gator Pack <br /> Method _ <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) — <br /> �.._.....ft. — ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) /n,I� <br /> Storage Location Casing type U"U <br /> Blank215V +,D' ft. Screen 10 Mn, . <br /> slot size .U2d <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water­a/-' `- �' Bags sand/gravel 3 <br /> Mix Ratios Filter Pack type/size- <br /> Installation Method Surge Block: - ( y/9) <br /> ) <br /> Quantity Installed Discussed with geologist: - �/ n ) <br /> Type of method <br /> EH 29 29 <br />