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�vIONITORING WELL INSTALLATION REP6KI <br /> Date:� CONSTRUCTION <br /> Premise Address: j G'i7A� Total Depth <br /> 2 Screen Length (from) (to)=J�� <br /> Well No.: AAS• 7 Filter Pack (from) .46 (to) <br /> Bentonite (from)_ (to) A i <br /> Inspector. _ �1�31.� Grout (from) t (to) , <br /> Drilling rig typ <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> _ <br /> Drilling Company: G I.>, <br /> Driller: �n casing <br /> 7— height <br /> Consultant C Amao_-L"� <br /> �7 'd <br /> Geologist ibproow �t?•Gyt� •. <br /> ABOVE-GROUND <br /> ODAFLETfON &ON <br /> SPECIAL PERMIT INFO. Ground surface <br /> Distance to sewer line <br /> pram <br /> Domestic well on site - (yam ft. <br /> If yes, location and distance ft. <br /> SAMPLING = S <br /> •(oral <br /> 0 soden <br /> Holding Temperature <br /> = <br /> Method _. <br /> Screening Method <br /> Tracking Sheet - n ) <br /> SPOILS SO, <br /> Storage Method Im MATERIALS/DEVELOPMENT `C <br /> Contamination Noted - (y/ ) 11 � AN'oI1 <br /> Storage Location aP�JtT� Casing type '1 Rio <br /> Blank '10 ft. Screen <br /> Slot size t0 <br /> GROUTING Bags cement �[ <br /> BuckCA bentonite l <br /> Depth to water 13V ZI Bags s vel <br /> Mix Ratios Filter Pac size <br /> Installation Method f� Surge Bloc • ( y i <br /> Quantity Installed Discussed with geog�st,: - 6?1 <br /> n ) <br /> Type of method �(��(( <br /> EH 29 29 <br />