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RONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: 393 N F.ar °� �Lj, -TTotal Depth <br /> Screen Length (from) SO (to) 250 <br /> �_ <br /> Well No.: SU E' 3S �3.1+-a.�-f.0w\ Filter Pack (from)— -(to) <br /> Bentonite (from)— —(to)�— <br /> Inspector: q Grout (from) (to) O <br /> �L Y/ BSc/ Drilling rig type <br /> Permit No. Auger O.D. 12- I.D. 8 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: '/T 3 casing <br /> k�G/ZCG�� C ✓e Gam/ height <br /> Consultant � <br /> Geologist_ / ABOVE—GROUND <br /> OCWPLE 1ON CHRWY-BOX <br /> COMPLEno <br /> SPECIAL PERMIT INFO. Ground 3uAaca <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) �o n <br /> If yes, location and distance - n <br /> m <br /> m <br /> SAMPLING slotted = a <br /> Bacton <br /> Holding Temperature <br /> Method = <br /> Screening Method = ` <br /> Tracking Sheet - (y/ n ) = c' <br /> n. = n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) q�r <br /> Storage Location Casing type I <br /> Blank ft. Screen ft. <br /> Slot size - 6241 <br /> GROUTING Bags cement <br /> _ Buckets bentonite 50 01" C411 <br /> Depth to water - a%s-sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br /> 3-5 <br />