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040NITORING WELL INSTALLATION REPOn" <br /> If <br /> a i /o �'t!1 c r <br /> Date: 12" //ZZ /�2L/ ro•/ii/f CONSTRUCTION <br /> Premise Address: a7T "� "— Total Depth <br /> Screen Length (from) 0 (to) <br /> Well No.: / e9 Filter Pack (from) (to) 7— <br /> Bentonite (from) Z (to) <br /> Inspector: Grout (from) 22— (to) <br /> Drilling rig type <br /> Permit No. /J Auger O.D.I8,0 g� I.D. ec <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: ��� `��`+ r / casing <br /> height <br /> Consultant c ,O T <br /> //�� e <br /> Geologist L�e-Qe&- "' --'Q ABOVE-GROUND <br /> C,0 LE CN �q� ' ( CNAISLET] X <br /> SPECIAL PERMIT INFO. <br /> n`dASS� LET] <br /> �P e' °`°"` �l8' <br /> r <br /> Distance to sewer line C s" 9 <br /> Domestic well on site - ( y n 1 N Z ft. <br /> If yes, location and distance - ���!, n. <br /> r u i ft. r: - -r <br /> SAMPLING r��1D � Bla ed <br /> n Becton <br /> Holding Temperature e VavW Fa* <br /> Method y •-'/ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) Ores <br /> n. <br /> SPOILS <br /> Storage Method / C MATERIAL /DEVELOPMENT <br /> Contamination Noted - y ) - loyC— <br /> Storage Location IkLl O1 �* Casing type #'� <br /> Blank ft. Screen_ZQ-__h• <br /> Slot size_--L6 <br /> GROUTING Bags cement y+)­0 + Z I <br /> Buckets bentonite <br /> Depth to water = Bags sand/gravel — <br /> Mix Ratios 1 r Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed 160+- T5 + Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH-29 29 p p <br />