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MONITORING WELL INSTALLATION REPO <br /> Date: 21 CONSTRUCTION <br /> rn�- L i <br /> Premise Address: 7N 1 iffl ib o Total Depth <br /> Screen Length (from) LO (to) <br /> Well No.: Filter Pack (from) !A (to) 41.q <br /> Bentonite (from) M(.Q1 (to) 34.5 <br /> Inspector: �,�lAlli . Grout (from) U's (to) I <br /> Drilling rig type .p -del <br /> Permit No. Auger O.D. L_?.- — I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: 160 1Lt0 fn1 casing <br /> height <br /> Consultant UM E 12 A V <br /> Geologist 6 <br /> ABOVE-GROUND <br /> COMPLETION (I CN <br /> SPECIAL PERMIT INFO. Ground Surfacs �• <br /> Distance to sewer line grout <br /> S <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft- <br /> LAft. <br /> v � m <br /> aA = <br /> SAMPLING T. — <br /> � socicn <br /> y <br /> Holding Temperature <br /> Method S �~ _ VIVW Pack <br /> Screening Method <br /> Tracking Sheet - y n ) //�� <br /> -AA—ft. _ IF 0 ft. <br /> SPOILS <br /> Storage Method _rilt� (hl � � MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n i <br /> Storage Location hil)- 11Casing type <br /> Blank � ft. Screen ft. <br /> Slot size 0.D10 <br /> GROUTING Bags cement 11 <br /> Buckets bentonite / <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 12, <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: - Gy/ n ) <br /> Type of method uk- <br /> EH 29 29 <br />