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Well No.: <br /> ALA) 7 <br />Inspector: A720fric/erfoq <br /> <br />Permit No. 4o7ao,9 <br />-ft <br />slortod <br />secion <br />2 <br />0 <br />gravsi Pack <br />ft. ft <br />Completion - Stove pipe/christie box (circle one) <br />casing <br />height <br />CHAISTY-80X <br />COMPLETION <br />Grourx1 Suriace <br />grout <br />ft. <br />ft <br />..IONITORING WELL INSTALLATION REPO. <br />e/f/ vie iv„ <br />Premise Address: S.-- Aame#,1444. 51-- Total Depth 37 <br />Screen Length (from) <br />Filter Pack (from) <br />Bentonite (from) <br />Grout (from) <br />Drilling rig type <br />z (to) 3 7 " <br />24) (to) 3-7 <br />/1" (to) z 4' <br />,s' (to) / ;- <br />Date: CONSTRUCTION <br />Auger O.D. g:5- '' I.D. <br />Drilling Company: e.aleade_ <br />Driller: <br />Consultant agp <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storage Method <br />Contamination Noted - ( y / n) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />MATERIALS/DEVELOPMENT <br />Casing type TV (— <br />Blank ').22 ft. Screen 22-37 <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n) <br />Discussed with geologist: - ( y / n ) <br />Type of method <br />EH 29 29