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jNITORING WELL INSTALLATION REPO. <br /> Date: /Z CONSTRUCTION �orL / <br /> Premise Address: �L � � Total Depth �� l <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to <br /> Bentonite (from) o) <br /> Inspector: S. Sct (d bff Grout (from) (to) <br /> Drilling rig type -5 <br /> Permit No. �.2�l Auger O.D. .2 I.D. 6. <br /> 9 Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: V c�I� <br /> Driller: 80N ��/�i�[,cC.J� casing <br /> height <br /> —qw <br /> Consultant /`�CL61��J �P}i2�' '4 <br /> 7//, T <br /> Geologist EI 6 M <br /> ABCVE-GRCUND CNASM430X <br /> CCMPLFTION COMPL-=TICN <br /> SPECIAL PERMIT INFO. (around Sufacs <br /> Distance to sewer line 0/1 grout <br /> Domestic well on site - ( y ft. <br /> If yes, location and distance - <br /> � ft. <br /> M <br /> 0 <br /> SAMPLING �lorod <br /> •ecicn = <br /> Holding Temperature �f G <br /> ack <br /> Method r Gam' ��F <br /> Screening Method <br /> Tracking Sheet n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/7n <br /> Storage Location O 5tT�' 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 Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />