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MONITORING WELL INSTALLATION REO <br /> Date: I Z / 10 ! �7S CONSTRUCTION �o/ <br /> - 3 y S C Total Depth <br /> Premise Address: Screen Length (from) pR (to) (n4 <br /> MM W— Filter Pack (from) y 0 (to)� <br /> Well No.: III n' Bentonite (from) 6 4- (to) <br /> P�� W I" Grout (from) t/ (to) <br /> Inspector: Drilling rig type I I a <br /> 3 Auger O.D. y �_ LD. <br /> Permit No. / Completion - Stove pipe/christie box (circle oney <br /> Drilling Company: �� \ <br /> �S \ casing <br /> Driller: height <br /> Consultant--- ry <br /> I <br /> Geologist J n � �� �r ABOVE-GROUND CHpZ7y.10X <br /> COMPLETION COMPLETICN <br /> Ground S <br /> SPECIAL PERMIT INFO. <br /> � proof <br /> Distance to sewer line 6 I ft <br /> Domestic well on site - y .n) 6. ft. <br /> If yes, location and ce - '21 _f✓ , 6q n <br /> e <br /> O <br /> SAMPLING a�c5on x <br /> Holding Temperature ) —_ <br /> Method S <br /> Screening Method .$< <br /> Tracking Sheet - (y/rn.) <br /> tt. <br /> SPOILS C/o <br /> Storage,Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) d D Casing type <br /> Storage Location Bi rO fro Screen 'LCA ft. <br /> Slotisize C Z <br /> Bags cement <br /> GROUTING Buckets bentonite' <br /> 8 I Bags sand/gravel Z <br /> Depth to water Filter Pack type/size <br /> Mix Ratios— J Surge Block: - (y hn) <br /> Installation M thud -YC � ` �r 1 <br /> Quantity Installed Discussed with geo st. . (y/ ) <br /> Type of method <br /> EH 29 29 <br />