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jNITORING WELL INSTALLATION REPO. <br /> Date: �`3�' CONSTRUCTION <br /> Premise Address: 14,91044<_ Lc_o� Total Depth <br /> Screen Length (from) (to) , <br /> Well No.: -Z_ Filter Pack (from) :{to) <br /> Bentonite (from) (to) <br /> Inspector: �v, �Ctt [�1'L_- Grout (from) (to) <br /> Drilling rig type _ -Permit <br /> 7- - <br /> Permit No. DZ Auger O.D. I.D. 2� <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> / �lfS <br /> Driller: ( N f KGCS aMt cl � casing <br /> height <br /> Consultant M <br /> Geologist C?(sem- �\11 S •- <br /> ABOVE-GACUND CHR*1rY-8CX <br /> OCNFLEMON COMPLEMN <br /> SPECIAL PERMIT INFO. around Surf act <br /> Distance to sewer line grout <br /> Domestic well on site - (y <br /> ft. <br /> If yes, location and distance - <br /> . ft. <br /> ft. <br /> - C <br /> SAMPLING alot•ai <br /> soden __ <br /> Holding Temperature °C = vW <br /> Method F <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) _ <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ <br /> Storage Location Or/ 51 rt�-- Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios '7 Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ ri <br /> Quantity Installed l Discussed with geol gist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />