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S,,)NITORING WELL INSTALLATION REPO-%W <br /> Date: 3 7i CONSTRUCTION <br /> Premise Address: Total Depth J-6 — <br /> Screen Length (from) s'o t (to) �o , <br /> Well No.: 3 Filter Pack (from)_ ° ' (to) 8`' <br /> Bentonite (from) (to) <br /> Inspector. K Grout (from) z.G r (to) s <br /> Drilling rig type <br /> Permit No. Auger O.D. e" - <br /> � r Completion - Stove pip clu'isue t (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> -F height <br /> Consultant IV <br /> 7/41 <br /> Geologist ASONE-GRCUND <br /> CC�WtSTY-SOX <br /> OM?LETiON <br /> COMPLeno <br /> SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer lineS� 9rocA <br /> Domestic well on site - (y/ „} - I'-ft. <br /> If yes, location and distance - <br /> o <br /> SAMPLING <br /> Holding TemperaWrepack <br /> Method ��" <br /> Screening Method <br /> Tracking Sheet (y/ n ) <br /> u <br /> ft. .y� <br /> .. yrq.+.. .µ ^• / Ile <br /> SPOILS / <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location,- rLy1 �LA _ Casing type <br /> BIank v -4.1 Oce ft. Screen -A�3 r`ca ft. <br /> Slot size z" <br /> GROUTCNG Bags cement e <br /> Buckets bentonite <br /> Depth to water / Bags sand/gravel_�rlo 3 <br /> Mix Ratios ¢ Filter Pack type/size <br /> Installation Method 7,-r^2 -Vr- .e Surge Block: - (y/ z <br /> Quantity Installed Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 <br /> /!'W�/ 5 <br />