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rA <br /> '.._JNITORiNG.WELL INSTALI ATION REPO. <br /> Date: /O JtS • �j2-- CONSTRUCTION <br /> Premise Address:. Total Depth---- 3 I <br /> Screen Length (from) G (to) <br /> Well No.: . Al Uj Filter Pack (frons) '6°� (to) <br /> Bentonite (from) �1, �,(to) 4� <br /> Inspector. �- SCS —'" Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 2. Auger O.D. LL). <br /> �Z <br /> Completionstie box (circle one) <br /> Drilling Company: <br /> Driller: A btu casing <br /> height <br /> Consultant -- <br /> - <br /> Geologist <br /> ABOVE-GRCJND Gii ZTY$OX ' <br /> OOIFLETION CGMPLEnON <br /> SPECIAL PERMIT INFO- G=ad Swfac* <br /> Distance to sewer line grail <br /> Domestic well on site - (y ID <br /> If yes, location and distance -- ft. <br /> SAMPLING _ 510rej <br /> Holding Temperature *C- . Pack <br /> Method C.t. ' <br /> Screening Method +old <br /> Tracking Sheet - (0/ n ) :x` <br /> SPOILS <br /> Storage Methods MATERIALS/DEVE4OPMENT <br /> Contamination Noted - (y <br /> Storage Location OAA - 61iLS7 Casing type 4r� Sr'W 4o RVG- <br /> Blank ft. Screen is ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios j . aftf.& Filter-Pack type/size <br /> Installation Method _ P rzifttkC Surge Block: - (OD/ n ) <br /> Quantity lnstallcd Discussed with geologist: - / n) <br /> Type of method Q!G kecu�b� <br /> EH 29 29 <br />