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MONITORING WELL INSTALLATION REP :' <br /> Date: > CONSTRUCTION <br /> Premise Address:.,�Zd _+� � Total Depth 30 <br /> Screen Length (from) (to} <br /> Well No.: L I.3 Filter Pack (from) _(to) ' 3 <br /> Bentonite (from) (to) 1 I <br /> Inspector: Grout (frt 1! (to) <br /> L3 Drilling rig type S mF "i <br /> Permit No.-11V 3 3�—_ _ Auger O.D. 1 11 .__ __ I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company-4 <br /> L' iL' <br /> Driller: casing <br /> .,.. <br /> height. <br /> Consultant '4 <br /> Geologist I P/�i �u�t.lC�]" w'^.l <br /> ABOVE-GROUND *CHRZW43OXCOWLETIOM <br /> SPECIAL PERMIT INFO. I IA,,� Ground Sudwo <br /> O �- <br /> Distance to sewer line `� grout <br /> Domestic well on site - (y/ n) j <br /> If yes, location and distance - f <br /> SAMPLING slo6d = s <br /> sadcn : <br /> Holding Te* n W pera a If �M = <br /> Method a — pack <br /> Screening Method W <br /> Tracking Sheet y/ n ) - <br /> 30 �a it- <br /> SPOILS <br /> Storage Method Ory 4-`�fits MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location� 01t! Casing type 1 <br /> Blank /C ft, Screen ft. <br /> Slot size -02"0 <br /> GROUTING Bags cement <br /> r Bucke -bgr►tonite �o paw <br /> Depth to water Ba sanggravel /°d f✓ <br /> Mix Ratios, _ Filte Pack type/size <br /> Installation Method Surge Block: - (y 11 )� , <br /> Quantity Installed- d� Discussed with ge gist: -C(�y y nType of method <br /> EH 29 29 <br />