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.MONITORING WELL INSTALLATION REPG.-. <br /> Date: L CONSTRUCTION <br /> Premise Address: 044) E. kQ.u— f&4 Total Depth 7 <br /> Screen Length (from) (to) 50 <br /> Well No.: I�lctJ - 5 Filter Pack (from) (to) <br /> Bentonite (from) 'S (to) <br /> Inspector: Grout (from) el S•'S (to) O <br /> Drilling rig type &rn....J k ae'"� <br /> Permit No. (oy I q S Auger O.D. S I.D. 4 <br /> '' l Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �1108�'W�" <br /> Driller: Ju A,\) + casing <br /> ,I � height . <br /> Consultant �r7 D � <br /> Geologist ��1G•w C �tt1 � <br /> ABOVE-GROUND <br /> COMPLETION CNRJSTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ? Gfout <br /> Domestic well on site - ( y/ n <br /> If yes, location and distance - ft' <br /> �y ft •s ft. <br /> C <br /> SAMPLING slatted <br /> e &#clan <br /> Holding Temperature C–. pack <br /> Method = �� <br /> Screening Method V <br /> Tracking Sheet - y/ ), ) <br /> �ft. igt>SPOILS 71 <br /> Storage Method 155,3j �V-O'�' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y O2�t 10 <br /> Storage Location Casing type �Glt <br /> Blank ft. Screen ft. <br /> Slot size . 6 I <br /> GROUTING I Bags cement 4"it 7 -9a <br /> Buckets bentonite ?� <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 4GZ - Filter Pack type/size <br /> Installation Method Surge Block: - ( y <br /> Quantity Installed x ')0 Discussed with geo ogist: -Cy n ) <br /> Type of method <br /> EH 29 29 <br /> ��y <br />