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�wJNITORING WELL INSTALLATION REPOI <br /> Date: CONSTRUC'T'ION <br /> Premise Address: _ Total Depth <br /> �nn�� - Screen Length (from) (to) 2 <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite Ufirom) 411 (to) <br /> Inspector: Grout (from (to)_ 0 <br /> Drilling rig 7e r <br /> Permit No. ` Z �C, Auger <br /> �� Completion - Stove pip e% uistie bo (circle one) <br /> Drilling Company: T l <br /> Driller: V,5�SO casing <br /> height <br /> Consultant <br /> GeologisQ ^1 w T <br /> ABOVE-GRCVNO CNRI.STY-BOX <br /> GOWLETiON COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n) A <br /> iL <br /> If yes, location and distance - ft. <br /> V' O <br /> On � <br /> SAMPLING abt:ad — _ <br /> ascdcn —_ 3 <br /> Holding Temperature — P <br /> Method jltR _ <br /> may. - <br /> Screening Method i _ <br /> Tracking Sheet ( n) ` <br /> ,......_.tt. .M ft. <br /> SPOILS <br /> r <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Note - (y/–n-) <br /> 1 <br /> Storage Location Casing typePL/c, L <br /> r <br /> Blank ft. Screen Z41 ft. <br /> Slot size . <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/s e <br /> Installation Me o Surge Block: - n ) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />