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MONITORING WELL INSTALLATION REPOnf <br /> Date: /S JIJOS <br /> CONSTRUCTION <br /> Premise Address: IIID ((J, j7 �/ �' �J z 2 <br /> Total Depth ;,5'r.cLl�� (Q'u••7 <br /> Well No.: ?i 2s Screen Length (from) f/ (to) !/ <br /> Filter Pack (from) <br /> Inspector: at Bentonite (from) . —(to) /o <br /> Grout (from) (to)—_ _ <br /> Permit No. Drilling rig type /SK�/ (to) <br /> / / Auger O.D. I.D. <br /> Drilling Company': {/r�(.�/ Completion Stove pip Christie box (circle one) <br /> Driller: et y f Z <br /> 3 casing <br /> Consultant_ eight <br /> Geologist <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. COMPLETC 07 FZTY-BOX <br /> Ground Sulacy COMPLETION <br /> Distance to sewer line /oon ' <br /> Domestic well on site - (y grout <br /> If yes, location and distance - <br /> ft. <br /> _ - a <br /> = o <br /> SAMPLING <br /> dotted � <br /> Holding Temperature mac. axion = <br /> Method I = VZVW Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) r __ <br /> 2D,7 Z I = <br /> SPOILS 2— — tL <br /> Storage Method axj wrw /L� ' <br /> Contamination Noted - (y M^TE ALS/REVELOPNM <br /> Storage Location g type 'V" p�� � <br /> Casin e <br /> Blank J2. F fr. Screen g, <br /> GROUTING Slot size 0/O <br /> Bags cement ..e�A <br /> Depth to water !U Buckets bentonite ! <br /> Mix Ratios J��y 7 p Bags sand/gravel n <br /> Installation Method �y <br /> Filter Pack type <br /> /size 2- <br /> Quantity <br /> Quantity Installed Surge Block: - !l/ n ) <br /> Discussed with geologist: - (yam <br /> EH 29 29 Type of methods <br /> �� /5-0 5 � _ 3, �(/ rs z� w. ex 1 <br />