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MONITORING WELL INSTALLATION REPOnf <br /> Z4l y <br /> u. WJ <br /> Date: -7�'L�3 CONSTRUCTION <br /> LewPremise Addr ss: TJ ✓ Total Depth �3 <br /> Screen Length (from) ?- (to) i 2� <br /> Well No.: � Filter Pack (from) (o- (to) <br /> Bentonite (from)(to) <br /> Grout (from) <br /> Inspector: Drilling rig type q <br /> Permit No. 0 C)3J 6 t Auger O.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> ::15 f Z casin <br /> .-'j-Q g <br /> Driller: he <br /> Consultant i0N Geologist Aj;VE-GROUND CHMS <br /> COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> 7 grout <br /> Distance to sewer line 1 •{S'( ft <br /> Domestic well on site - (y/ n) <br /> If yes, locationand distance - n' <br /> • <br /> _ m <br /> _ m <br /> C <br /> O <br /> SAMPLING slotted _ B <br /> toc5on <br /> Holding Temperature P <br /> ack <br /> Method = <br /> Screening Method =_ <br /> Tracking Sheet - (y/ n ) <br /> n. L .w <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) L �L <br /> Casing type h <br /> Storage Location Blank mfr, Screen <br /> Slot size <br /> GROUTING Bas cement IO I <br /> Buckets bentonite I YZ- c <br /> N Bags sand/gravel <br /> Depth to water Filter Pack type/size 3 <br /> Mix Ratios `J Surge Block: -(W n) <br /> Installation Method ` Discussed with geologist:- y n <br /> Quantity Installed Type of method <br /> EH 29 29 <br /> aC1raL2. 1.2 <br />