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JNITORING WELL INSTALLATION REPC <br /> Date: /a� CONSTRUCTION <br /> Premise Address: f 4' /�Li �U/�.dByj Total Depth 30' <br /> , Screen Length (from) 34 (to)� <br /> Well No.: 4i/� ' c Filter Pack (from) 30, _(to) <br /> c Bentonite (from) (to) ' <br /> Inspector. Grout (from) G T ' (to) a <br /> Drilling rig type <br /> Permit No. �J ( I Auger O.D. I.D. Sl' <br /> Completion - Steve-pipe/c t�p,ox (circle one) <br /> Drilling Company: �o�./�y� mellJ-t . <br /> Driller: �� `�� casing <br /> ��' � height <br /> Consultant -tw, <br /> Geologist <br /> AE&E4ROUND CNAISTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N� grout <br /> Domestic well on site -Q/ n) <br /> ' ft. <br /> If yes location and distance - ft. <br /> SAMPLING tlored Y <br /> Holding Temperature �� o :` _ pack <br /> Method L&I6 Z , cc _ �� <br /> Screening Method I —_ <br /> Tracking Sheet y/ n ) - <br /> 4W41V rf iY 1r, kA q-, C, _._._ft. ..__. <br /> SPOILS <br /> Storage Method SID � �u, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y (V) <br /> Storage Location I V A r kl-?lCasing type �� <br /> Blank /5 ft. Screen <br /> Slot size I- 01 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ��. 9 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -#101-//-'.I- S <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />