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"MONITORING WELL INSTALLATION REPS <br /> Date: l - - 1 -U CONSTRUCTION <br /> Premise Address: 1 �� U - — Total Depth ' <br /> Screen Length (from) -7 CP ' (to) Cr ' <br /> Well No.: 0_� le) Filter Pack (from) to (to) <br /> Bentonite (from) /Q (to) cP Z_ <br /> Inspector. L aLh?z:)►VA Grout (from) P (to)S eA �P <br /> Drilling rig type M 0 fe 3-� <br /> Permit No. 'SK9 0cZ U 9 S 3 Auger O.D. 0 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company- C% (�e <br /> Driller: ComLLr S � _ casing <br /> height <br /> C✓ '4' <br /> Consultant <br /> Geologist <br /> ABCVE-GROUND CNRZ7Y4= <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfaos —� <br /> Distance to sewer line <br /> pfout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> M <br /> SAMPLING : — <br /> alot•.ad r. � <br /> sacicn <br /> Holding Temperature %r = <br /> Method — Ravi Pack <br /> >. — <br /> Screenino Method <br /> Tracking Sheet - ( y/ n ) ~' <br /> ft. —ft. <br /> SPOILS <br /> Storage MethodD(-U fy\zO MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n <br /> Storage Location_ lQ, L��,i n nC���� Casing type V�_ S 6w'a6 Z/y <br /> Blank lQ ft. Screen / ft. <br /> Slot size O O <br /> GROUTING Bags cement <br /> Buckets bentonite C44 S - <br /> Depth to water Bags sand/gravel <br /> Mix Ratios I ha'x to Filter Pack type/size <br /> Installation MethodSurge Block: - (y/ n ) <br /> Quantity Installed `f Q 5�o Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />