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WNITORING WELL INSTALLATION REPOit <br /> Date: / /o O/� CONSTRUCTION �/ <br /> Premise Address: �v Total Depth r <br /> N Screen Length (from) 0.5 (to) b0•5 <br /> Well No.: ✓� "�h " Filter Pack (from) 1 L (to) 58 <br /> Bentonite (from) SS (to) 53 z <br /> Inspector: Grout (from) 5) L (to) <br /> Drilling rig type 5-ft.lo <br /> Permit No. y�\ Auger O.D. (v Z I.D. 52 <br /> /_ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:/- �(Jy( �- <br /> Driller: ��' ' Z - casing <br /> height <br /> Consultant <br /> Geologist •- <br /> /180VE GROUND CNRISTY BOX <br /> CONFLEfION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SvAace <br /> Distance to sewer line gf01t <br /> Domestic well on site - ( y/ n ) ft- <br /> If yes, location and distance - <br /> � 5ft ft. <br /> — m <br /> — c <br /> SAMPLING slotlad — <br /> sacdion = T <br /> Holding Temperature = VaYW Pack <br /> Method = <br /> Screening Method =_ <br /> Tracking Sheet - Cy/ n ) <br /> '70-5 ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2„ <br /> Storage Location Casing type <br /> Blank eD L ft. Screen_ M ft. <br /> Slot size D� <br /> GROUTING Bags cement NIf <br /> _ Buckets bentonite (Nt' GG O <br /> Depth to water ^ Bags sand/gravel <br /> Mix Ratios °I Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed 55 + 65Y 4- fo Discussed with geologist: - (y n ) <br /> Type of method <br /> EH 29 29 <br /> //6 ',,/ <br /> ` ®S, A <br />