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*MONITORING WELL INSTALLATION REPO <br /> Date: <br /> CONSTRUCTION <br /> - <br /> Premise Address: �?? yv`t/L Total Depth <br /> Well No.: Screen Length (from) 1 23 (to) t <br /> Filter Pack (from) I (to) <br /> Inspector. Bentonite (from) (to) os <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D. _ I <br /> ol � Completion - Stove pip stie boxcircle one) <br /> Drilling CompaCnyf: w`�i� "'�' w `-v' <br /> Driller:_ v Cvy�- casing <br /> pheight <br /> Consultant � �V n IV <br /> f f- UUU <br /> 4 <br /> Geologist <br /> ABOVE-GR04UND <br /> COMPLETION CHRim-aoX <br /> SPECIAL PERMIT INFO COMPLEnCN <br /> ®Orourd Suisra <br /> Distance to sewer line otart <br /> Domestic well on site - (y/ n ) i <br /> If yes, location and distance - <br /> a <br /> m <br /> SAMPLING = o <br /> dorm — 'c <br /> sacicn '> <br /> Holding Temperature — <br /> Method _ _ pavalPack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) — <br /> : _ <br /> SPOILS '�,�^ <br /> Storage Method "� MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - n ) - <br /> Storage Location Casing type Z 7 p <br /> U <br /> Blankft. Screen g, <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Mix Ratios Depth twater Bags sand/gravel <br /> os Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />