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4.10NITORING WELL INSTALLATION REPO,— <br /> Date: 1 112 l�z CONSTRUCTION <br /> Premise Address:fl, /zu tel' C� iV� Total Depth <br /> 7 _ Screen Length (from) (to) 1 V <br /> Well No.: 44M) f ' �j Filter Pack (from) (to) <br /> Bentonite (from) N 4" (to) <br /> Inspector. 1V4Grout (from) 1 (to) cF <br /> C,, �� Drilling rig type <br /> Permit No. 7 Auger O.D. G�'hi I.D. <br /> /�� ✓�/ / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: / <br /> Driller: C'� "� ` casing <br /> _ height <br /> Consultant—L i Aj 6'- 4m _ '4 <br /> Geologist -- <br /> ABOVE-GRCUND CHR1STY-80X <br /> COtvFLEf fCN CCMPL—=nCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer lineN,Q grout <br /> Domestic well on site - (y n) 3 �0 <br /> If yes, location and distance - <br /> SAMPLING ilot:od - c <br /> sec1cn — <br /> Holding Temperature <br /> Method _ gnvwF <br /> ack <br /> Screening Method 'c — <br /> Tracking Sheet - (y/ n ) <br /> t L . <br /> SPOILS <br /> Storage Method �5 y- MATERIALS/DEVELOPMENT <br /> Contamination Noted - n') <br /> Storage Location /C`��! °`�°' Casing type <br /> Blank ft. Screen ilk ft. <br /> Slot size _ � n <br /> GROUTING Bags cement 2 UAI,f <br /> Buckets bentonite n) o <br /> Depth to water Bags sand/gravel K, <br /> Mix Ratios . jjg t d Y( � _ Filter Pack type/size <br /> Installation Wthod. `r/l Surge Block: - Y' n ) <br /> Quantity Installed / ��^^ � Discussed with ologist: -CYj <br /> n ) <br /> ' Type of method i',1 n c,& <br /> EH 29 29 <br /> I��ti� v U I <br />