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N. <br /> %w,JNITORING WELL INSTALLATION REPC <br /> Date: Q114z= CONSTRUCTION <br /> Premise Address:, r Total Depth <br /> Screen Length (from) (to) `f <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) -3'A <br /> Inspector: Grout (from)_ 3� (to) <br /> Drilling rig type JP�– <br /> Permit No. Auger O.D. f II D j2 <br /> Drilling Company: 6� Completion - Stove pipe stie ox (circa one) <br /> Driller: casing <br /> height <br /> Consultant J. <br /> Geologist c� f <br /> ABOVE-GRC4JN0 zryY 3OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Qord Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y AV) �, ft. <br /> if yes, location and distance - <br /> Va' 0 <br /> C <br /> SAMPLINGslonad <br /> M: <br /> — <br /> Holding Temperature <br /> Method a// ^ ° _ grew!Pacts <br /> 1. _ <br /> Screenin;Method — <br /> Tracking Sheet - U7n) � l <br /> . ...�tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - / qrl <br /> Storage Location Casing type <br /> Blank W ft. Screen Ct. <br /> Slot size 0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios a Finer Pack type/size <br /> Installation Method :Y:jWJ44 iA2 Surge BIock: - ( y k10 <br /> Quantity Installed Discussed with geologist: y�n ) <br /> Type of method <br /> EH 29 29 <br />