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40NITORING WELL INSTALLATION REPO <br /> Date: ` ` i 1 L CONSTRUCTION (�z 2 6> I P x L S <br /> Premise Address: S`J Total Depth foo t <br /> ��""� ����__ 5 `� Screen Length (from) l (to) <br /> Well No.: V+� i/-u 2 (-2 Z S Filter Pack (from) f (to) <br /> Bentonite (from) (to) <br /> Inspector: C lrt f �/ c - Grout (from) (=� (to)� <br /> �i Drilling rig type <br /> Permit No. �i �/ Auger O.D. R� I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: :height <br /> ing <br /> 1 - , <br /> Consultant <br /> � nVE DA-Geologist 961'4'r / CLrT <br /> LETION CFffi1S7Y 80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAaca <br /> Distance to sewer linen' grout <br /> Domestic well o tte (y/ <br /> If yes, locatio nd d' tan - ft- <br /> R. <br /> tt. <br /> N <br /> C <br /> O <br /> SAMPLING aloft" <br /> on <br /> Holding Temperature ,t P <br /> Method <br /> Screening Method 0V0 bZ s 7 <br /> Tracking Sheet - (y/ n) <br /> w,- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y rn <br /> Storage Location Casing type S'lAA <br /> 6(0 <br /> Blank ft. Screen <br /> Slot siz 1p. 02 <br /> GROUTING Bags cement 4 <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix RatiosL'7Filter 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 61-511 , 1 , <br />