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ONITORING WELL INSTALLATION REPO <br /> Date: 3( CONSTRUCTION <br /> Premise Address: q23 I III II-s7.tTotal QDepth <br /> � � �- � Screen Length (from) (to) <br /> Well No.: ��J Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)— <br /> Inspector. <br /> from) (to)Inspector. Grout (from) (to) <br /> Drilling�02(-GAJ Auger ng e <br /> Permit No, ger O.D. (�" I.D. <br /> Completion - Stove piWeluistie box (circle one) <br /> Drilling Company: <br /> Driller: 17IT— <br /> OCAvFLETION <br /> casing <br /> height <br /> ConsultantGeologist OA80 NDCf4iIM-BOX <br /> CCMPLE 014 <br /> SPECIAL PERMIT INFO. Ground BuAx� <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) fL <br /> If yes, location and distance - <br /> 85 <br /> O <br /> O <br /> SAMPLING dorsad = 3 <br /> aoc'cn <• __ <br /> Holding Temperature _ = R, q pack <br /> Method = <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) <br /> qO lei l36 n. ` = 7 `i '� tL <br /> SPOILS KYS-S Pu-5 KVO"� KFS-S <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Z t V[l <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Rados Filter Pack type/ 'ze <br /> Installation Method Surge Block: -( y n ) <br /> Quantity installed Discussed with geologist: -�j n ) <br /> Type of method <br /> EH 29 29 <br />