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MONrropiNG WELL INSTALLATION REI;"-cT <br /> Dace: SP CONSTRUCTION <br /> Premise Address: ZS 2 N. `Slsc`S S Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) _(to) <br /> Well No.: Bentonite (from) (to) <br /> . ►� Grout (from) (to) <br /> Inspector <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> �-�-- Completion - Stove Pip tie box (circle one) <br /> Drilling Company- 1�� `"" C"" <br /> casing <br /> Driller. height <br /> Consultant <br /> Geologist A3CVE-GROUND \\ <br /> COMPI=,CN <br /> SPECIAL PERMIT INFO. G=nd Sul." <br /> r <br /> yrait <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) _------`t- <br /> If yes, location and distance - L <br /> _ - 73 <br /> a <br /> SAMPLING s10 — <br /> wccn <br /> Holding Temperature _ <br /> Method _ <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location . Casing type ' <br /> Blank ft. Screen ft <br /> Slot size - <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block. - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ a) <br /> Type of merhod <br /> EH 29 29 <br />