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SNITORING WELL INSTALLATION REPO. / -Cn j�,j <br /> Date: CONSTRUCTION <br /> , <br /> Premise Address: Total Depth n <br /> Screen Length (from) (to) /S <br /> Well No.: / ti--1 1 J Filter Pack (from)—(to)tT' <br /> Bentonite (from) (to)(to) 4 I <br /> Pnspector. Grout (from) ' (to) u f <br /> Drilling rig type �h' I <br /> Permit No. Auger O.D. 2A I.D. V11 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �i�-<-��' _ <br /> Driller: �r casing --` <br /> T height <br /> Consultant <br /> Geologist ABOVE-GROUND <br /> COMPLETION C7 RZTY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfx* <br /> Distance to sewer line Omit <br /> Domestic well on site - (y/ n6Z-ft, <br /> If yes, location and distance - j tt. <br /> ft. <br /> �i <br /> — a <br /> — e <br /> — C <br /> SAMPLING slow <br /> 0 tac'cn — <br /> Holding Temperature .". = pravd padt <br /> Method -tau W <br /> Screening Method <br /> Tracking Sheet -, y n ) � � <br /> .ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) ` <br /> Storage Location Casing type <br /> Blank fr. Screen " ft. <br /> Slot size 0,02 <br /> GROUTING Bags cement <br /> 1 1 Buckets bentonite <br /> Depth to water ' 1 ? (J Bags sand/gravel AD <br /> Mix Ratios Filter Pack type l !2- <br /> Installation Method Surge Block: ( y n ) <br /> Quantity Installed Discussed wit -E ologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />