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JNITORING WELL INSTALLATION REPG, <br /> Date: CONSTRUCTION <br /> Premise Address:—// / �/��I C� Total Depth 301 <br /> z Screen Length (from) 30 (to) 16 <br /> Well No.: I�w as w-oZ 3 Filter Pack (from) 3d (to) <br /> c l Bentonite (from) ' (to) <br /> Inspector: S�erhss Grout (from) G a ' (to) 0 <br /> /� (f Drilling rig type <br /> Permit No. " �!�/ Auger O.D. I.D. S'' <br /> / Completion - �y mine/-chdstie-box (circle one) <br /> Drilling Company: � °L l�/ ZA-/-- /� a/o <br /> Driller: <br /> 7- height <br /> Consultant 'ers'l1� <br /> ol <br /> Geologist /`/��C/� /� /�- �l+"�� •- <br /> ABOVE-GRCUND CtiFi1STY-80X <br /> COMPLECION COMPLEMCN <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> Distance to sewer line N <br /> grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> — m <br /> SAMPLING C <br /> '• o <br /> tlot•.v.� .:: � <br /> ►ccicn <br /> Holding Temperature s� o r _ F <br /> ack <br /> Method r /�c _r�—7760 G VZ77 M' _ <br /> Screening Method C _ <br /> Tracking Shce - ( y/ n ) <br /> SPOILS <br /> Storage Method P*ij S7 --JVD C'�r��l�r --- MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - ( y/4 nUG <br /> Storage Location f9 S'-, � /l�y� /,{�(�� Casing type f <br /> Blank lb ft. Screen o2 0 ft. <br /> Slot size /o - O/ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water / Bags sand/gravel <br /> Mix Ratios Filter Pack type/size off, <br /> Installation MethodSurge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> ��� 66< l* <br />