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1I6NITORING WELL INSTALLATI N ORIF <br /> fld �� ,. + <br /> Date: ���-Ul� CONSTRUCTION <br /> Premise Address: ;�(15? S. hTotal Depth c/O <br /> Screen Length (from) /0 ' (to) yo ` <br /> Well No.: Filter Pack (from) '-,,o &)WSL ` (to) sa.f' <br /> Bentonite (from)<` 310 (to) -10, s ' <br /> Inspector. e4_ (---7 y Grout (from) to) <br /> Drilling rig type hfv /lay✓ c .� <br /> Permit No. Auger O.D. /n " I.D. <br /> Completion - Stove pipe/c sde x (circle one) <br /> Drilling Company: U <br /> Driller: ( /Wz �� casing <br /> height <br /> Consultant //"f — 17>+� !1e �. o V <br /> 6406-84st Y iW; _ <br /> ABOVEGROUND C>� <br /> COMPLETION COAAPL_-=ncN <br /> SPECIAL PERMIT INFO. --Grou <br /> Distance to sewer line grout <br /> Domestic well on site - (6j/ n ) <br /> If yes, location and distance - ft. <br /> ^r ft. <br /> SAMPLING �lorai = <br /> { taeien — <br /> Holding Temperature N o 30 = <br /> Method _ paYa Pack <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method_ � - _ �^A^^� MATERIALS/DEVELOPMENT <br /> N <br /> Contamination oted - (y/®) <br /> Storage Location a- Casing type �4 " dL <br /> Blank ft. Screen JO ft. <br /> Slot size �— i] <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water `"31 Bags sand/gravel a/� f <br /> Mix Ratios Filter Pack type/size 7V Eliz S <br /> Installation Method —/v[ 1, cots Surge Block: - (y ADF <br /> Quantity Installed Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br /> N2 <br />