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MONITORING 4VR INSTALLATION REPORT <br /> Date: 28��z CONSTRUCTION <br /> f <br /> S13-5- <br /> Premise Address:_ 019�WVLZ 3-3 . V�/'1q CA Total Depth L/o <br /> nn Screen Length (from) (to) <br /> Well No.: �– �c S�–� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: P�''LP <br /> (� Completion - Stove pipe/christie box (circle one) <br /> Co'e Dom'l'''�5 <br /> Driller: <br /> casing <br /> height <br /> Consultant SAZC <br /> YA <br /> Geologist rci') <br /> ABOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/ n ) n <br /> If yes, location and distance - <br /> ft. <br /> = m <br /> — O <br /> C <br /> SAMPLING = <br /> alonad _ c <br /> Bacton — <br /> Holding Temperature <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - (Y/n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />