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0NITORING WELL INSTALLATION REPO <br /> iv1 <br /> Date: Z� 2 CONSTRUCTION <br /> Premise Address: T 5 �1 Total Depth tf L D <br /> Screen Length (from) <br /> Well No.: �`1�1� �� Filter Pack (from) Z (to) <br /> Bentonite (from) 1 (to) <br /> Inspector: 0._ Grout (from)—(to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. 10 <br /> 1 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company,: `yy�"�'- -� <br /> Driller: �`1'^ 7�- casin <br /> Q ItOVE-GRCUND <br /> height <br /> Consultant fc� E r^A —QV-F <br /> Geologist � �t 1 . - ETION CNRZ1Y-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAxs <br /> grout <br /> Distance to sewer line 1 I(. <br /> Domestic well on site - (y/ n ) _S ft. <br /> If yes, location and distance - 2 ft. <br /> �. . <br /> = m <br /> — o <br /> = m <br /> = c <br /> SAMPLING slotted <br /> - taction — - <br /> Holding Temperature = tin i Paclo <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n �" Ve <br /> Storage Location Casing type <br /> Blame ft. Screen • W ft• <br /> Slot size O7� - <br /> GROUTING Bags cement / <br /> Buckets bentonite Z — <br /> Depth to water Bags sand/gravel — <br /> Mix Ratios �39�� " Filter Pack type/size <br /> Installation Method �NKSurge Block: - y n) M(1X^ <br /> Quantity Installed d / Discussed <br /> ss method with geologist: - (y� <br /> YP <br /> EH 29 29 <br />