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MONITORING WELL INSTALLATION REPO. <br /> Date: CONSTRUCTION <br /> Premise Address:, © fid Total Depth S <br /> Screen Length (from) 3(f) (to) L0 <br /> Well No.: /i;'�✓ G/, �, Filter Pack (from) "30 -(to) '�a- <br /> Bentonite (from) 55-- (to <br /> Inspector: C� l' � Grout (from) (to) <br /> Drilling rig type <br /> Permit No, ��- � - Auger O.D. <br /> / Completion - Stove pipe%christie box (circle one) <br /> Drilling Company:_ c I--..- — - <br /> Driller; casing <br /> —The Lght <br /> IV <br /> Consultant <br /> Geologist <br /> ABCVE-GACUND C}iMM-8CX <br /> COMPLETION CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface + ---� <br /> Distance to sewer line =' gfout <br /> Domestic well on site <br /> If yes, location and distance - <br /> — a <br /> — a <br /> SAMPLING slorA <br /> acn — <br /> Holding Temperature P-, F <br /> ack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y <br /> SPOILS <br /> Storage Method 4s rk -!:)1 r MATERIALS/DEVELOPMENT <br /> 1 Contamination Noted - r <br /> Storage Location ��l -" Casing type <br /> Blank0 ft. Screen Zed ft. <br /> Slot size C7/ <br /> GR0L71NG Bags cement _ <br /> Buckets bentonite 1 ,Xr c.Je <br /> Depth to water Z 3 Bags sand/gravel_ <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - ( y <br /> Quantity Installed Discussed with geo ogist: -(:;�)n ) <br /> Type of method <br /> EH 29 29 <br />