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•`'MONITORING WELL INSTALLATION REPO' <br /> Date: 1�-�6I �S� CONSTRUCTION <br /> Premise Address: -Scpcj S+• rlo.6 E- Total Depth o` <br /> Screen Length (from) (to)_ nc <br /> Well No.:_ n)-S Filter Pack (from) 3 ` (to) b o <br /> Bentonite (from) -ST.-:C(to) <br /> Inspector: ,b IAWc\v, Grout (from) S____(to) 3 5• < <br /> Drilling rig type <br /> Permit No. Auger O.D. SC Yd" D. <br /> Completion - Stove pipe/ stie box circle one) <br /> Drilling Company. S L S <br /> Driller: V-jc..r1 Q. 0-\d,c,-WA casing <br /> TM fheight <br /> —WW7F <br /> Consultant �V <br /> 7 <br /> Geologist -- <br /> ABOVE-GROUND CHMM-SOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) s•S n, <br /> If yes, location and distance - <br /> e <br /> _= c <br /> _ c <br /> SAMPLING sloitad = c <br /> section <br /> Holding Temperature p cU2yccb, i c< grx,w paCK <br /> Method � � <br /> Screening Method P l n <br /> Tracking Sheet - ((I)/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/(:4)) <br /> Storage Location Casing type Z P v <br /> Blank Ljj ft. Screen Zo' ft. <br /> Slot size 1 0z0 <br /> GROUTING Bags cement <br /> Buckets bentonite l L� <br /> Depth to water Lf + ' Bags sand/gravel S 5 <br /> Mix Ratios Filter Pack type/size -0.3 <br /> Installation Method Surge Block: - (y/0 <br /> Quantity Installed Discussed with geologist: - & n ) <br /> Type of method <br /> EH 29 29 <br />