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*ONITORING WELL INSTALLATION REPO <br /> CN <br /> i,5 Oa Z <br /> Date: l b SOW CONSTRUCTION <br /> Premise Address:—'S;) J ! 14 2-& Total Depth i 6-Z) <br /> 1Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No..V,::� _ Auger O.D. = I.D. L4 ,- rn ej-- <br /> Drilling Company: <br /> (� Completion - Stove pipe/cliristie box (circle one) <br /> �s�'►�CQ �� <br /> Driller: V casing <br /> f he?ght <br /> Consultant L '4 <br /> Geologist c 1 l 4iT <br /> Jl$OHE-GRCUND cl -SL Tf-aOX %� <br /> C0 A�IwcTfC�N GOMP7C�N <br /> / <br /> SPECIAL PERMIT MO. pend salad <br /> Distance to sewer line gout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - f?. <br /> ft. <br /> 4" 0 <br /> - r <br /> S� Z <br /> SAMPLING s <br /> tacicn <br /> Holding Temperature <br /> Method — I+T'Y°IPack <br /> Method <br /> Screening i" <br /> :+ <br /> Tracking Sheet - [y <br /> SPOILS <br /> Storage Method MATERIALS/DEWI.OPMENT � <br /> Contamination Noted - [y/ n ) 7 <br /> Storage Location Casing e 6g- 40 puc <br /> Blank U ft. Screen ZO fr. <br /> Slot size b <br /> GROUTING Bags cement <br /> �� > uckets cntonite <br /> Depth to water san avel <br /> Mix Ratios Filler Pack type/size <br /> Installation Method Surge Block: - (y/ 12 ) <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> EH 29 29 <br /> Type of method <br />