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.iONITORING WELL INSTALLATION REPG_ _ - <br /> i <br /> Dater CONSTRUCTION <br /> Premise Address: � to I b)rj. ty Total Depth 46 <br /> 5 2 Z/ Screen Length (from) 15 (to) <br /> Well No.:�— Filter Pack (from) 45 (to) 13 <br /> Bentonite (from) 13 (to) h <br /> Inspector: Grout (from) ll (to) 0 <br /> Drilling rig type t-lnll.ou) L- <br /> Permit No. Auger O.D. 25 -3/� / I.D. <br /> V Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 4 <br /> Driller: ROUert NId4G¢Ah �.iwIFS V16`b7 5tnj 6jn,1 p casing <br /> c height % <br /> Consultant CJ V� k <br /> Geologist L.u+ c s'rNr � <br /> ABOVEGROUND <br /> COMPLETION VXrY.8OX <br /> SPECIAL PERMIT INFO. Ground Surfxw <br /> Distance to sewer line UIn,K.yl,OW n Grout <br /> Domestic well on site - ( y / 1 ft <br /> If yes, location and distance - i5 <br /> 0 <br /> SAMPLING dotted _ S <br /> wctlon —_ <br /> Holding Temperature <br /> grurel pack <br /> Method <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) ��[r•- <br /> ft* no <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( V n ) 2 „ P JG �� 4D <br /> Storage Location Casing type <br /> Blank IS ft. Screen 36 ft. <br /> Slot size °201 <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water �� • 8 2� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 591 4�0,gAnck E) <br /> Installation Method Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />