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•rvIONITORING WELL INSTALLATION REPSn!' <br /> Date: CONSTRUCTION <br /> Premise Address:_ Total Depth_ -cq 2.(v,5� <br /> Well No.: Screen Length (from) 7 (to) Lt - <br /> i� �l $ D Filter Pack (from) 1A �l (to) <br /> Inspector: �-�e . �r t ra rd Bentonite (from) 8' (to) s ' <br /> Grout (from) 3 s (to) <br /> Permit No. S!L"` 0 C Drilling rig typed-.,t ,{ <br /> Auger O.D. 8' I.D._ <br /> DrillingCompany:. oo�w P r� �t :lir Completion tove pt ei(chnstie of:, (circle Driller:_ ( -co'n, <br /> — �!� 11 � casing <br /> Consultant \A,k j 4Z-^ Kit a �� height <br /> GeologistJ (' cl -5- $l b} T <br /> Frp+.cr s u5c.a^'� ABOVE-GROUND <br /> COMPLETION CHRI,STY-BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surface <br /> Distance to sewer line Q LIQ grout <br /> Domestic well on site - FY/n ) 0 <br /> If yes, location and distance - 3-5, 15' . ft <br /> U Itl•5 ft. ft. <br /> a; <br /> :x <br /> O <br /> SAMPLING <br /> 0 <br /> elOttYd <br /> Holding Temperature teC40n <br /> Method <br /> Screening Method — <br /> Tracking Sheet - (y/n ) ; _ J'- <br /> SPOILS ft' <br /> Storage Method <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type G�O <br /> Blank fr. Screen_ 15 ' ft. <br /> GROUTINSlot size 0_n f G <br /> Bags cement_ -S rs <br /> Depth to water_ 1 I I2 Buckets bentonite_ &4�x <br /> Bags sand/gravel 1 <br /> Mix Ratios_ 3 ri� —LIE c,a Vi vw�_ Filter Pack type/size �� t <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed <br /> Discussed with geologist: - (y <br /> EH 29 29 Type of method <br />