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90NITORING WELL INSTALLATION REPO <br /> Date: ,,/ p y CONSTRUCTION / <br /> Premise Address: d 1' / � �Y� Total Depth (O <br /> //,,'.� <br /> ���� Screen Length (from) (to) <br /> Well No.: leW - /J Filter Pack (from) (to) <br /> Bentonite (from) (to)7/ <br /> Inspector: Grout (from) (to) L7 <br /> C� Drilling rig type Gsu-E <br /> Permit No. 6t / Z Auger O.D. S, I.D. <br /> DrillingCompany: <br /> ®� Completion - Stove pipe/christie box (circle one) <br /> 1��l6tlt_ <br /> Driller. -6c erg_ casing <br /> n height <br /> Consultant �� ,rir- �.+acn T <br /> Geologist W- T <br /> ABOVE-GROUND CNAISTY BOX <br /> OOAFLETION P <br /> SPECIAL PERMIT INFO. Ground SuAace <br /> Distance to sewer line < 50 ' gran <br /> Domestic well on site - (y� ft <br /> If yes, location and distance - <br /> tt. <br /> ft. <br /> — a <br /> = m <br /> SAMPLING detmd = Z c <br /> 4c n soc5en <br /> Holding Tempe,�atur 1. <br /> Method (� (� <br /> Screening Method ' O✓M = <br /> Tracking Sheet - 41 n ) <br /> SPOILS <br /> Storage Method_! 6-�t l+� MATERIALS/DEVELOPMENT <br /> Contamination Note n ) <br /> Storage Location We'd flA4 4 Casing type <br /> ' Blank_ S fr. Screen fr. <br /> Slot size ALO' <br /> GROUTING Bags cement <br /> Buckets bentonite d <br /> Depth to water 5� Bags sand/gravel D <br /> Mix Ratios / wA f Filter Pack type/size 9 <br /> Installation Method 'j 2WSurge Block: -(Vn) <br /> Quantity Installed '12-0 .o Discussed with geologist: - (y n ) <br /> Type of method <br /> EH 29 29 <br />