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'40NITORING WELL INSTALLATION REPO-- <br /> Date:- �L _J 5 CONSTRUCTION <br /> Premise Address: �– o Total Depth /;,0' <br /> Well No.: °, IdT'-3' S'17." �' "� Screen Length (from) (to) �6o <br /> _t,.) �_ <br /> _ : Filter Pack (from)_ 3c6 (to) bo <br /> Inspector: _ } *)IA,,,, rBentonite (from)_ �_(to)��____ <br /> te'A i Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. " <br /> Christie boa (circle one) <br /> Drilling Company: Completion - Stove pip S� � <br /> Driller:_ VIA casing <br /> Consultant height <br /> Geologist 1��.1�;, i�c��� ('�(�p1_ 7F <br /> Ai0N -GROUND <br /> COMPLETION CHRISTY-80X <br /> SPECIAL PERMIT INFO Ground SuCOMPLETION <br /> Distance to sewer line grout <br /> Domestic wel. on site - (y/ n ) <br /> If yes, locatio.1 and distance - -- G ft. <br /> ...L_Oft. ft. <br /> SAMPLING c <br /> stoned c <br /> tocton <br /> Holding Temperature_ <br /> Methodc�,, = Gni Pads <br /> Screening Method_ <br /> Tracking Sheet - n ) ' _ <br /> ft. ft. <br /> SPOILS <br /> Storage Method <br /> Contamination Noted MATERIALS/DEVELOPMENT <br /> - { /� - <br /> Storage Loca�ion on,�_ ,�- a I p r�n� Cr{. Casing type fk/�— <br /> Blank------q-(2—ft. Screen__ <br /> GROUTING Slot size -a-) e) <br /> Bags cement <br /> Depth to water Buckets bentonite 3 <br /> Mix Ratios 6�a,6 cP,u,e..h f .r .l Bags sand/gravel_ ��• A�, <br /> "d� � Filter Pack type/size * � n,, <br /> Installation MethodAA Surge Block: - (y/n <br /> Quantity Installed_ Discussed with geologist: - (©/ n ) <br /> EH 29 29 Type of method <br />