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ivIONITORING WELL INSTALLATION REPOtcT <br /> Date: //� ���� CONSTRUCTION <br /> Premise Address: %/�� Alpe"Jy �d Total Depth 40 <br /> Screen Length (from) (to) <br /> Well No.: SV /s Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) b <br /> p Drilling rig type r/NaE 55 <br /> Permit No. Auger O.D. AD /Z I.D. <br /> / _ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: T! <br /> Driller: low 7,- casing <br /> height , - <br /> Consultant <br /> Geologist - T <br /> ABOVEGROUND CNAISiY80X <br /> COA'PL ETION COMP <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ?i <br /> ft. <br /> If yes, location and distance - 2UP <br /> L ten. tt. <br /> - a <br /> = m <br /> = m <br /> = c <br /> SAMPLING alottad = 8 <br /> aec5on — <br /> Holding Temperature = P <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> �n. = n. <br /> SPOILS _` Q ku'"'�' r <br /> I ,� �l� �'tfp Y� <br /> Storage Method a 'Ha 57 /_ MATERIALS/DEVELOPMENT <br /> Contamination Noted ( y/ n ) r/ O <br /> Storage Location Casing type Ale-,� <br /> Blank 7,S ft. Screen 20 h. <br /> lot size -020 <br /> GROUTING �rBags cement / <br /> Buckets bentonite O <br /> Depth to water Bags sand/gravel ?15 <br /> Mix Ratios + Filter Pack type/size <br /> Installation Method Surge Block: - (yn <br /> Quantity Installed -F'Z$ o Discussed with geo gist: - ( / n) <br /> Type of method <br /> EH 29 29 <br /> O 'll"� !/ SSE• �S ���"Z/ <br />