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1 ry .'ONITORING WELL INSTALLATION REPO <br /> 47 <br /> Date: CONSTRUCTION <br /> Premise Address; V rJv. Total Depth ":�?-6 <br /> Screen Length (from) 2 0 (to) S' <br /> Well No.: Filter Pack (from) a- / (to) <br /> Bentonite (from):� '_(to)-.2 <br /> Inspector: Grout (from) -3 ` (to) <br /> G� ��3 Drilling rig type :6 u1 <br /> Permit No. (. Auger O,D, I.D. <br /> Completion - Stove pipe/ s e (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> he{ght <br /> Consultant <br /> Geologist <br /> ABOVE-GRGUND CtiF4 M-Sox <br /> coMPLErcona coAKEnoN <br /> SPECIAL PERMIT INFO. Ground Sudacs <br /> Distance to sewer line ! grout <br /> Domestic well on site -1Wn`) <br /> If yes, location and dkstancce - n- <br /> 4 CO <br /> fn N <br /> SAMPLING slonod M <br /> aac�cn <br /> HoIding.Teinperaturegnvw Pack <br /> ;r <br /> Method <br /> Screening Method <br /> Tracking Sheet n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - { <br /> Storage Location / PU-O . Casing type i <br /> ` <br /> Blank ft Screen •! <br /> Slot size o)— <br /> GROUTING " Bags cement <br /> —� Buckets bentonite• `� ! <br /> Depth to water Bags sand/gravel S <br /> Mix Ratios 1'o Filter Pack type/sized w <br /> Installation Method1A.LL 21tQ_ Surge Block; - (y/ zi <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />