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NITORlNG WELD INSTALLATION REPO, <br /> Date: A `z CONSTRUCTION <br /> Premise Address: OD w ui3 Total Depth a <br /> Screen Length (from) (to) C-W <br /> Well No.:. Filter Pack (from)_ (to) )Q2' <br /> Bentonite (from) AW reo (to)� <br /> Inspector: Grout (from) (to) <br /> ! - .Drilling rig type <br /> fl <br /> Permit No. .r, Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie.box (circle one) <br /> Drilling Company: u <br /> Driller: i cao ing <br /> height <br /> Consultant r <br /> 7T <br /> Geologist r. .. <br /> ABOVE-GROUND C�iRISTY-BQX <br /> CCMPL TION CCMPLZnCN <br /> SPECIAL PERMIT INFO. Ground Swfacs <br /> Distance to sewer line U , 9rout , <br /> N <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> SAMPLING tiot'.a.! y+ <br /> M <br /> ssdon <br /> Holding Temperature h <br /> Method d �P <br /> Screening Me od A7,0 1 <br /> Wracking Sheet ( y/ n ) <br /> SPOILS i . l -Z <br /> i <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Notedy h—, <br /> Storage Location Q(v2 �-" Casinge <br /> Blank d ft, Screen ?YY <br /> Slot size <br /> GROUTING .. Bags cement <br /> Buckets bentonite <br /> Depth to water-,_ ,r0 Z ' ,r Bags sand/gravel <br /> Mix Ratios Filter Pack type/size W a ; <br /> .Installation Method Surge BIock: - (y/ n } <br /> Quantity Installed i' „ Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 !' <br /> i <br /> l �� ��3 <br />