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mONITORING WELL INSTALLATION REPOr.i <br /> Date: / GB /,-3 Zo,-C r J �DS� CONSTRUCTION <br /> Premise Address: k8/ / ,~ Total Depth ��J <br /> Screen Length (from) / (to) <br /> W AIIN oW 1 No.: v" �� 3 Filter Pack (from) (to) 0- <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) O <br /> �3 Z6 Drilling rig type C*t'� <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: 1<,-7 f 1 � / casing �--� <br /> — d height <br /> Consultant 17 <br /> IL 7 v-m <br /> Geologist GSL[: T <br /> ABOVE-GROUND C4-iAlSTY-BOX <br /> OOWFLETION PLETION <br /> SPECIAL PERMIT INFO. mrd Surf acs <br /> Distance to sewer line M, grout <br /> Domestic well on site - ( y/ n ) <br /> r ft. <br /> If yes, location and distance - O.S <br /> �. <br /> ft. <br /> ft. <br /> a <br /> = m <br /> I — a <br /> _ . m <br /> SAMPLING dotted <br /> wct c n <br /> Holding Temperatur = Ian Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> lC)-5 ft. T _ ft. <br /> SPOILS <br /> Storage Method 55 rip�-� �U�X MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ` If <br /> Storage Locations (� ,�c,�.� Casing type <br /> Blank ft. Screen In ft. <br /> Slot size DID <br /> GROUTING Bags cement <br /> Buckets bentonite t'/Z— T-F-36 <br /> Depth to water Bags sand/gravel '�Od <br /> Mix Ratios '2kot t�'f 4��` -� Filter Pack type/size 2-. <br /> Installation Method d Surge Block: - (y n ) <br /> Quantity Installed 55+50 t 150 ttSo-t SO Discussed with gen ogist: - ( y�n <br /> Type of method v <br /> EH 29 29 <br />