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ONITORING WELL INSTALLATION REPO <br /> Date d ;'OUCONSTRUCTION <br /> Premise Address: 5�ou Qp .� " Total Depth 72-- <br /> Screen <br /> yScreen Length (from) 71 (to) G <br /> Well No.: Filter Pack (from) 11 (to) G <br /> Bentonite (from) - (to)� <br /> Inspector: � Grout (from) (to) <br /> Drilling rig type b - tt "L <br /> Permit No. Auger O.D. X I.D. �{ <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Comp <br /> a'n'y,��,QQ/ / <br /> Driller:T" ' f casing <br /> height <br /> Consultant <br /> IFA-15 <br /> Geologist 6X4 C 1mac <br /> �— ABOVE-GROUND &Zpa�oox <br /> COWLETION <br /> SPECIAL PERMIT INFO. Gnxind Su fats <br /> Distance to sewer line L �� grout <br /> Domestic well on site - ( y n Gl 1. ft <br /> If yes, location and distance - ft <br /> o <br /> — m <br /> � C <br /> SAMPLING /�n01 slotted = `' E <br /> Holding Temperature = nv l pad, <br /> Method � � = <br /> Screening Method <br /> Tracking Sheet ( n ) 71 <br /> SPOILS 7 <br /> Storage Method �J MATERIALS/DEVELOPMENT <br /> Contain nationNot d - n ) <br /> Storage Location 6NO -tom lq—a—" Casing type <br /> Blank ft. Screen—2— ft. <br /> Slot size <br /> GROUTING �/ Bags cement t <br /> Buckets bentonite I <br /> Depth to water ^ 3z Bags sand/gravel 1pps <br /> Mix Ratios 360*1 1 4�'f 3% Filter Pack type/size - <br /> Installation Method -� - Surge Block: - (y n <br /> Quantity Installed 50� Discussed with geo ogist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />