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`% E ONITORING WELL INSTALLATION REPOrr!" <br /> Date: ��,[/ CONSTRUCTION <br /> Premise Address: �(GCOZ /U �!/G �/jl, f/' Total Depth <br /> Screen Length (from) A I (to) 6 U <br /> Well No.: GV / Filter Pack (from) —(to) g�' <br /> Bentonite (from)1� (to) — <br /> Inspector: Grout (from) r7`3 (to) — <br /> Cy� Drilling rig type li4 f 11 0-5 <br /> Permit No. U (D Auger O.D. g I.D. <br /> Drilling Company:. �- <br /> Completion - Stove pipe/christie box (circle one) <br /> / <br /> Driller: ` -�''`- f /�' casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION C4iAJSTY 80 <br /> N <br /> SPECIAL PERMIT INFO. Ground Su lacy <br /> Distance to sewer line of out <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - <br /> _SLft. <br /> = a <br /> = m <br /> SAMPLING slotted _ c <br /> section — - <br /> Holding Temperature = <br /> Method = P <br /> ack <br /> Screening Method -' <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Zit ry� <br /> Storage Location Casing type r <br /> Blank U ft. Screen <br /> Slot size ,Dl O <br /> GROUTING Wags cement '"+-I <br /> / Buckets bentonite 3-0 <br /> Depth to water r �Z Bags sand/gravel <br /> Mix Ratios - Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br />