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OONITORING WELL INSTALLATION REPO <br /> rz31> I P -63S <br /> Date: CONSTRUCTION <br /> Premise Address: 1 Ltv 7�� L0,WJ r IM�Lf-- Total Depth O S <br /> 4Lttip� S�vN � Screen Length (from) t-r (to)�v <br /> Well No.: l� S Filter Pack (from) (to) <br /> ( Bentonite (from) (to) <br /> Inspector: w rwM l_ Lr( �I e24 � Grout (from) <br /> 5 r&01+ Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company:_ S�.✓� <br /> Completion - Stove pipe/christie box (circle one) <br /> �^^1�{,Cr� <br /> Driller: casing <br /> 1 �` / 1 height <br /> ConsultantyT% .{/L <br /> Geologist S W�— _D C'e-YS <br /> ABOVEGROUND <br /> COMPLETION CHRIST 4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO, Qroub Sa} <br /> Distance t4onandl <br /> grout <br /> Domestic - / n ) n <br /> If yes, to ance - <br /> n. <br /> SAMPLING = <br /> slotted = $ <br /> secdon .xi Holding Temperature grAYWPack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT2 s/ g y <br /> Contamination Noted - (y/ <br /> Storage Location Casing type drJ <br /> Blank ft. Screen LJ ft. <br /> Slot size D-J <br /> GROUTING Bags cement 'Z 4 <br /> Buckets bentonite t <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size '&I L[ <br /> Installation Method r— Surge Block: - (y/ n ) <br /> Quantity Installed 2 1 Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />