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INITORING WELL INSTALLATION REPO: <br /> Date: (�d-7//0 CONSTRUCTION <br /> Premise Address: /�� 7�? Total Depth V/ <br /> Screen Length (from) t/ (to) / <br /> Well No.: ��Z Filter Pack (from) 3 a -(to)_!_Z— <br /> Bentonite <br /> to) /ZBentonite (from) /Z (to)/D <br /> Inspector: �I( Grout (from) (to)-Lk— <br /> Drilling <br /> to)_ /UDrilling rig type_ <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan <br /> Driller: casing <br /> height <br /> Consultant_ ,�-e-C/ <br /> Geologisto p S � <br /> ABOVE-GROUND <br /> COMPLETION CHRIM-BOX <br /> SPECIAL PERMIT INFO. Ground Stais COMPLETION <br /> ac <br /> Distance to sewer linely^—` — ori <br /> Domestic well on site - (y/� <br /> If yes, location and distanceO' ft' <br /> ft ft. <br /> = m <br /> q <br /> C <br /> SAMPLING = ° <br /> slotted — <br /> sec5on — <br /> Holding Temperature <br /> Method — Vs`W Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> it <br /> Storage Location Casing type a" i A' S 7b <br /> Blank ft. Screen ft. <br /> Slot size 0.0�v <br /> GROUTING Bags cement <br /> Buckets bento.i O <br /> Depth to water 0-«- h Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n <br /> Quantity Installed Discussed with geologist: t /4,1k ) <br /> Type of method_ I-A <br /> EH 29 29 <br /> �9 <br />