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VNITORING WELL INSTALLATION REP019 <br /> Date: 4101-q/ CONSTRUCTION <br /> 1/fl <br /> Premise Address: Total Depth a_�'fj <br /> /L/GU Screen Length (from) -LZ` -(to) _ <br /> Well No.: / / Filter Pack (from) <br /> Bentonite (from) ►I'' (to) <br /> Inspector. Grout (fro (to)CA <br /> Drilling rig type <br /> Permit No. >� cf 6 f Z-- Auger O.D. 10 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultan �� <br /> 7, 19 <br /> Geologist �- <br /> ABOVE-GACUND CHA M43OX <br /> COMPLETION COMPLEEMN <br /> SPECIAL PERMIT INFO. around Surfaca <br /> Distance to sewer line VZ, grout <br /> Domestic well on site - (y <br /> If yes, location and distance - pp ft. <br /> a.1Lft. <br /> i+• r <br /> O <br /> SAMPLING clored <br /> aocicn <br /> Holding Temperature/ " <br /> z. _ gravW pads <br /> Method (7\T 1) <br /> — <br /> Screening Wthod = <br /> Tracking Sheet y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method Qv� etff�Lc MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n • ((-;1 J� <br /> Storage Location Tti S Casing type <br /> Blank ft. Screen <br /> Slot size 2 <br /> GROUTING Bags cement t <br /> Buckets bentonite UCS <br /> Depth to water �' Bags sa I /gravel <br /> Mix Ratios - Filter Pack type/ 'ze <br /> Installation Method. Surge Block: - y% Il ) <br /> Quantity Installed Discussed with geologist: - C/ n ) <br /> Type of method <br /> EH 29 29 Pp Z j Ud <br /> � l � <br />