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40NITORING WELL INSTALLATION REPO <br /> Date: Z 1 ( � CONSTRUCTION Cpl l D Pij <br /> Premise Address: illi vVti//_c Total Depth S <br /> Screen Length (from) i (to <br /> Well No.: !r t 5 Filter Pack (from) (to G <br /> Bentonite (from) (to 9 <br /> Inspector: T WW L Grout (from) (to) D <br /> �i Drilling rig type <br /> Permit No. `7 Auger O.D. $7 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> II C x lzK /J1 <br /> Driller: TAIL / (f�o�J ca ' ng <br /> h iig <br /> ..(/ <br /> Consultant � tiH ,�/ <br /> Geologist �A uJ D Ptnr S� IABOVE-G T <br /> COMPLETION CHFIL Y-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ground Surfaces <br /> Dist ce to sewer ' e grout <br /> Do esti well o site - y/ n ) <br /> If es, to atio d dist ft' <br /> ft. <br /> ft. - <br /> - m <br /> 1h <br /> 0 <br /> — o <br /> C <br /> SAMPLING slotted = d <br /> sac�on — <br /> Holding Temperature <br /> Method = V"',Pack <br /> Screening Method yl}7 <br /> Tracking Sheet - (y/ n ) n f o D 6D S <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type 5046 �V L <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite� w�tlr <br /> Depth to water 'C. a Bags sand/gravel r�At <br /> 17 <br /> Mix Ratios L� rSa Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />