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MONITORING WELL INSTALLATION REPO <br /> Date: I y�l D - CONSTRUCTION <br /> p ,^, �P ,( � 1 <br /> Premise Address: 8so Foo&4 Total Depth I3� <br /> Screen Length (from) 11-l ' (to) I t'fr— <br /> Well No.: z[ W C Filter Pack (from)_I' 'q' (to) I ft <br /> Bentonite (from) t1%.S" (to) 10 <br /> Inspector: Grout (from. 10 (to) <br /> Drilling rig type U <br /> Permit No. Auger O.D. 1L� — l— D. T141 — <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �- <br /> Driller: casing <br /> ( eight <br /> Consultant � <br /> � <br /> IET <br /> Geologist�f4w M ql� BVdACUN CHAS7Y-30XJ CONFLET COMPLEncis! <br /> SPECIAL PERMIT INFO. <br /> ` Ground Surface Tom` <br /> Distance to sewer line �/�✓\ grout <br /> Domestic well on site - ( y/ n) 111,9 . ft. <br /> 1 \1 <br /> If yes, location and distance - <br /> R. <br /> - a <br /> _ w <br /> SAMPLING liar." = 'E <br /> saricn <br /> Holding Temperature pwctyadc <br /> Method =_ <br /> Screening Method r <br /> Tracking Sheet - (y/ n ) <br /> a�3�ft. = M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) N <br /> Storage Location Casing type <br /> Blank l(7 h. Screen 2.o ft. <br /> Slot size I &.Z6 I.OZo <br /> GROUTING Bags cement <br /> Buckets bentonite / <br /> Depth to water 1 Yv _ Bags sand/gravel3 <br /> Mix Ratios _ Filter Pack type/size <br /> ze <br /> Installation Method Surge Block: - U/ n ) <br /> Quantity Installed Discussed with geologist: - 0/ n ) <br /> Type of method <br /> EH 29 29 <br />