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- NITORING WELL INSTALLATION REPO' <br /> Date: 3� L��� CONSTRUCTION <br /> Premise Address: ��y ?3 �� /o�PA,.,� <br /> Total Depth <br /> W� Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 4";, (to) <br /> Bentonite (from) Z3 (to) Z� <br /> Inspector. Grout, (fro )_y� (to) S <br /> Drilling rig type u <br /> Permit No. Auger O.D. R Y4 I.D. <br /> Drilling Company: u+�, <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: Fm_1 <br /> casing <br /> height <br /> Consultant <br /> Geologisr_� Gi <br /> • APAVE-GRCUND <br /> COWPLETION Ck-A STY 30X <br /> SPECIAL PERMIT INFO. ��g� GOM�+•PLE"TICH <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) 11 <br /> If yes, location and distance - ft. <br /> "25; <br /> v• � m <br /> C <br /> SAMPLING — o <br /> z o<*1 - — <br /> Holding Temperature — <br /> Method — ¢""'�r <br /> Screening Method <br /> Tracking Shcet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type,�,146k q of 1L/ <br /> Blank 2 t ft. Screen ft. <br /> Slot size 0.070 _ <br /> GROUPING Bags cement <br /> i Buckets bentonite <br /> Depth to water "3 Bags sand/gravel <br /> Miz Ratios ,e,r�._�.d Filter Pack type/size .O-L 0 <br /> ,Installation Method Surge Block: - (y 161) <br /> Quantity Installed yAIH 1 j Discussed with geologist: - �/n ) <br /> Type of method <br /> EH 29 29. . <br />