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'1110NITORING WELL INSTALLATION REPOt.!-� <br /> Date: �E� g, ��� ( *4-) CONSTRUCTION <br /> Premise Address: Total Depth S9 <br /> Screen Length (from) (to) <br /> Well No.: �� Filter Pack (from) (to) 3Y <br /> Bentonite (from) `F z (to) 30,5' <br /> Inspector: tA- Grout (from) 3 6 2 (to) <br /> �3js� Drilling rig type_ <br /> Permit No. Auger O.D. 7 I.D. '�(2— — <br /> Com letio ve pipe/christie box (circle one) <br /> Drilling Company: � �� <br /> Driller: /`�K� r 2i nasi g <br /> heig <br /> Consultant GLGd d 2 <br /> Geologist <br /> /ABOVE-GROUND <br /> COMPLET{ON CNAfSTY-80X <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> r <br /> Distance to sewer line ' S� grout <br /> Domestic well on site - ( y On 30.5. <br /> If yes, location and distance - 3 ft. <br /> .s n. <br /> ft. <br /> C <br /> SAMPLING = . <br /> sac5on <br /> Holding Temperature <br /> Method — � W Pack <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method ./> Gam' �(�-�'� a MATERIALS/DEVELOPMENT <br /> Contamination Noted - ty/ n ) n r <br /> Storage Location Casing type Z�� �V C <br /> Blank 3$ ft. Screen 2 ft. <br /> Slot size .016 , <br /> GROUTING Bags cement NA-11 <br /> Buckets bentonite r 2 70-SU <br /> Depth to water Bags sand/gravel 650*` <br /> Mix Ratios i t 5 u Filter Pack type/size 12 <br /> Installation Method .A Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> �r <br />