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�V ONITORING WELL INSTALLATION REP <br /> Date: 11L CONSTRUCTION-J�, <br /> Premise Address: ivy ( '�� G� Total Depth �U <br /> Screen Length (from) <br /> Well No.: Filter Pack (from) (to)`fir <br /> Bentonite (from) T {toT — <br /> Inspector: Grout (from) 3 0 {to) <br /> Drilling rig type c/'I - 7J(_ <br /> Permit No. Auger O.D. I.D. 3 �' <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller• —rte casing <br /> height <br /> Consultants-tel`'� � T <br /> Geologist R"(_� T <br /> ABOVE-GROUND CHRL5TY43OX <br /> COMPLETION CCMPLEnON <br /> SPECIAL PERMIT INFO. Ground Suda" <br /> Distance to sewer line y�� / grout <br /> Domestic well on site - (y/on ) ��ft. <br /> If yes, location and distance - tL <br /> W — <br /> JR r <br /> 4 <br /> SAMPLING <br /> Holding Temperature p <br /> Method <br /> Screening Method 4LI=12 <br /> Tracking Sheet y n ) <br /> SPOILS <br /> Storage Method Xc— <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y gn Y U <br /> PUCE <br /> Storage Location g=-S BCasing W <br /> Blank SJ ft. Screen /s— ft. <br /> SIot size .42.2-0 <br /> GROE3'I'[NG Bags cement <br /> Buckets bentonitf02 <br /> Depth to water l Bags sand/gravel 'z- 4 <br /> Mix Ratios �% Filter Pack type/s2 /z_ <br /> Installation Method Surge Block: - ( <br /> Quantity Installed Discussed with gt: -((� n) <br /> Type of method <br /> EH 29 29 <br />