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- `TONITORING WELL INSTALLATION REPS'^T <br /> Date:_ /00/° ' CONSI•RUCTION <br /> Premise Address: Ko/ L' lNL. Total Depth <br /> WeNo.:_ vV! � 7 r Z `�b,��� �j Screen Length (from) (to) <br /> 11 r , Filter Pack (from) (to) <br /> p Bentonite (from) (co) <br /> Inspector._�-�« C Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller. <br /> • casing. <br /> height <br /> Consultant <br /> Geologist /�✓Lllr►-- \ <br /> • ABO E-G R CON D C2-A:STY-30X <br /> CO WP LETSO N CO{Y{,'L'T1CN <br /> SPECIAL PERMIT INFO. mrd Stzlac-# <br /> Distance to sewer line aroc <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> —ft. <br /> ft. <br /> -V <br /> C <br /> SAMPLING — <br /> zlorv.� >; C <br /> D sQcicn •• -� <br /> HoldingTem erature — <br /> Method�f <br /> Screening Method <br /> Tracking Sheet (�} /'n <br /> ft. — 14 rtt. <br /> SPOILS <br /> Storage Method MATE RIALS/DEVE[.OPN ENT <br /> Cont4mination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mik Rados Filter Pack type/size <br /> installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed vtith geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29. . <br /> Some `.►' <br />