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..,iONITORING WELL INSTALLATION REPG... <br /> Date: /�'C�LG�L �P ��� CONSTRUCTION <br /> Premise Address: ` t *7C5 /�t4� r� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> 2)"6 <br /> � �,�l Drilling rig type LETS <br /> Permit No. 2/u/ O (p Auger O.D. r lU 1.D. IV-6 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: —/1WA4 r casing <br /> height <br /> Consultant b 7-167 <br /> Geologist �W6 ��aG/ZAJ 7 T <br /> ABOVE-GROUND <br /> COMPLETION CNAlSTY480X <br /> OMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> 9 (�r grout <br /> Distance ta%dwev—line <br /> Domestic well on site - ( y <br /> If yes, location and distance - ft. <br /> ft. - <br /> ft- <br /> = m <br /> C <br /> SAMPLING tlorted = `' c <br /> Holding Temperature <br /> Method = s <br /> ack <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> IFft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ �„�,� � /�, /� <br /> Storage Location 031 /1'C' , Casing type 74 y <br /> Blank ZC) ft. Screen ZO ft. <br /> Slot size02d <br /> GROUTING Bags cement <br /> �g Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size /Z. <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />