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iv,oMTORING WELL INSTALLATION REPOnI' <br /> Date: -1- 6/ CONSTRUCTION <br /> / C <br /> Premise Address: JAQ� J v Total Depth <br /> Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) 14t.Z (to), 2TI <br /> w Grout (from) Y. (to) O <br /> Inspector: Drilling rig type M ;7 <br /> 3p �y Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> �.- D casing <br /> Driller: '�`'� height <br /> Consultant ow�5'� <br /> Geologist [��fiC � ABOVE-GROUND <br /> cowPLETCN comPLEMON <br /> J Ground Surface -Tut <br /> SPECIAL PERMIT INFO. JJ���� JJJ <br /> n ot«,t <br /> Distance to sewer line ft- <br /> Domestic well on site - (y/ n) Sia Z ft <br /> If yes, location and distance - <br /> C 21 I, tof�. <br /> = c <br /> slotted <br /> SAMPLING sscioac5o _ S I <br /> (� n '- <br /> Holding Temperature 4° ` G""°lPack <br /> Method � n. <br /> ^ <br /> Screening Meth D 1-D _ <br /> Tracking Sheet -(gY n) _ ft- <br /> �tt. <br /> SPOILS o <br /> Storage Method s� �`)�� MATERIAL S/DEVELOPMENT Q A <br /> Contamination Noted - (y n Casing type Zr ^ <br /> Storage Location Blank ft. Screen--leg—ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> r, Bags sand/gravel <br /> Depth to water g Filter Pack type ze 3 <br /> Mix Rados N fir, Surge Block: - g ) - <br /> Installation Metho M-"t { Discussed with eo ogi t: - <br /> Quantitylnstalled (tO4 Type of method LA 0 <br /> EH 29 29 <br />