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GNITORING WELL INSTALLATION REPO* <br /> Date: N --, 1,-1V CONSTRUCTION <br /> Premise Address: Total Depth i Z <br /> Screen Length (from) j/1 (to) <br /> � <br /> Well No.:9Fw ' !PJ Filter Pack (from)ii2' (to)_ 7 s <br /> � Bentonite (from) <br /> Inspector. Grout (from) (to) k " c" <br /> Drilling rig type 4,rLnJ It <br /> Permit No. Auger O.D. I.D. <br /> n Completion - Stove pipe/christie box (circle one) <br /> Drilling Compan i I <br /> i <br /> ca n <br /> hes t <br /> Consultant �� <br /> Geologist <br /> \ABCVE•GACUND Ct4i1M-SOX <br /> COWLETION COMPLETION <br /> SPECIAL PERMIT INFO. GraundSurf <br /> Distance to sewer lines rout <br /> Domestic well on site - ((y n ) G 0. ft. <br /> If yes, location and distance . c z _; ft. <br /> SAMPLING dortsd <br /> sac9on "< __ <br /> Holding Temperature" A/�, " <br /> ack <br /> Method _ gwW F <br /> Screening Method = <br /> Tracking Sheet • ( y/C <br /> It. M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - Q y,•, n ) <br /> Storage Location /J7+ -r i CIe Casing type <br /> Blank l ft. Screen % ft. <br /> Slot size . 02D <br /> GROUTING Bags cement <br /> r Buckets bentonite <br /> Depth to water Bags sand/gravel #z '1 + G _ <br /> Mix Ratios j , "L.-.- Filter Pack type e # e, <br /> Installation Method r Surge Block: n ) <br /> Quantity Installed 'SD �(�# Discussed wit eologist: -K"Y7/ n ) <br /> Type of method n.� . (� <br /> EH 29 29 <br />