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4 <br /> % ONITORING WELL INSTALLATION REPO <br /> i <br /> Date: �l ' 0 7 CONSTRUCTION <br /> Premise Address: jP6 Aj' `1 Total Depth /01 <br /> Screen Length (from) /46 (to) <br /> Well No.: Filter Pack (from) d (to)— q <br /> Bentonite (from) 6 (to) Z <br /> Inspector: Grout (from) L (to) 3 <br /> p (! Drilling rig type <br /> Permit No. �/l �l�T Auger O.D. I.D• <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: /� <br /> Driller: � '`1 1r /'� fi ° casing <br /> height <br /> Consultant a <br /> Geologist 4lllt ABOVE-GBCUNp <br /> COfvPLETfON jrPL <br /> -80X <br /> TI N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 7 gra <br /> Distance to sewer line Q <br /> Domestic well on site - y n ) %Z {t, <br /> If yes, location and distance - /SO <br /> m <br /> {" O <br /> SAMPLING slagad c <br /> tec7on i <br /> Holding Temperature gravel pads <br /> Method <br /> s..4 _ <br /> Screening Method <br /> L <br /> Tracking Sheet - (y/ n <br /> /0 6 <br /> SPOILS �� / <br /> Storage Method f� �`�'�' MATERIALS/DEVELOPMENT <br /> Contamination Noted - ©n } ► r <br /> Storage Location /. f Casing type 1 <br /> Blank ft. Screen S ft• <br /> Slot size . 020" <br /> GROUTING Bags cement <br /> Buckets bentonite 2 -3 � <br /> Depth to water ~- �2– Bags sand/gravel_ 2– - <br /> Mix <br /> –Mix Ratios O- '{ q Filter Pack type/size # <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/n } <br /> Type of method <br /> EH 29 29 <br />