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F10NITORING WELL INSTALLATION REPO <br /> Date: v d CONSTRUCTION z <br /> Premise Address: fA /`' y'U�Cif� Total Depth � J J <br /> Screen Length (from) ? (to) Ll8 <br /> Well No.: Filter Pack (from) 373 (to) 4's <br /> Bentonite (from) s (to) <br /> Inspector: ���'• Grout (from) /-?!(to)- 3�- <br /> �� .Drilling rig type -� <br /> Permit No. rT Auger O.D. � I.D <br /> �� ) Completion - Stove pip cl e o ircle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant �,L_ <br /> Geologist <br /> 7/4 <br /> ABOVE-GAMNO CHMM-Sox <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line Gfout <br /> Domestic well on site - (y/ ft. <br /> If yes, location and distance - !l ft. <br /> v� m <br /> a <br /> SAMPLING <br /> s*ricn — <br /> Holding Temperature_ VaYel Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) — <br /> 5 ft. <br /> SPOILS <br /> Storage Method �J� y�� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type 2 ��l G/O <br /> Blank 1-(g ft. Screen _i5—' ft. <br /> Slot size 020 <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> Depth to water /�/ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size ze 7 <br /> Installation Method Surge Block: - (V TIT <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> 30. <br />