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SNITORING WELL INSTALLATION REPO <br /> Date: /d I CONSTRUCTION <br /> Premise Address: /67Y - a Total Depth lI <br /> Screen Length (from) //i (to) 7 <br /> Well No.: f' l t) "Z Filter Pack (from) i i - (to) 7- <br /> Bentonite (from) 1 i (to) <br /> Inspector: •+ <br /> Grout (from) c� (to) > . _<-x. <br /> Drilling rig type <br /> 10 I.Permit No. Au O.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 11'.""6_j <br /> Driller: j casing <br /> height <br /> Consultant <br /> Geologist S /AA (114 i '" <br /> A80VEr,RCUND Ct815TY-8OX <br /> COhFLETION COMPLETION <br /> SPECIAL PERMIT INFO. G=rxj Sumacs ^per <br /> Distance to sewer line i� ' 7fO'tU�Pi <br /> Domestic well on site y/ nP 1t, <br /> If yes, location and distance - <br /> = o <br /> SAMPLINGq dorsi <br /> A)/I s 'an — S <br /> Holding Temperature = pnvd Padt <br /> Method ' <br /> Screening Method <br /> Tracking Sheet - (y/ n ) 7x: <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank r 7 ft. Screen <br /> Slot size B Z� <br /> GROUTING Bags cement <br /> Buckets bentonite SD r <br /> Depth to water Bags sand/gravel. <br /> _ <br /> Mix Ratios Filter Pack type r/�' e <br /> Installation Method�Aoa Surge Block: - V n ) <br /> Quantity Installed_ L6 / / o Discussed with geologist: -;( n ) <br /> Type of method 0-< ,- <br /> EH 29 29 <br />