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k..,.}NITORING WELL INSTALLATION REPO"-/ <br /> Date: 112 A73 CONSTRUCTION <br /> 1 <br /> Premise Address: Q Total Depth_ <br /> Screen Length (Tom) (to) 6, <br /> Well No.: Filter Pack (from) -(to) <br /> � <br /> ,_.—T,.....,..,........,...,..__..�..... ento (from) 9�f, (to) <br /> Inspector. 5 Gro (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. /;V" I <br /> Completion- Stove pi s x ' d <br /> e boe one) <br /> Drilling Company: � <br /> Driller: V—V <br /> casing <br /> height <br /> Consultant <br /> Geologist .� V- <br /> 690 AE&E-GROUND <br /> CONFL TION <br /> SPECIAL PERMIT INFO. G=nd Swfw <br /> Distance to sewer line grou <br /> Domestic well on site - (y/ n) a (:, , <br /> If yes, location and distance - B. <br /> ft. <br /> SAMPLING <br /> sacIca <br /> Holding Tem er ture o � =_ <br /> ack <br /> Method .� F <br /> Screenin;Method ov oY1 <br /> Tracking Sheet ! n} �l <br /> SPOILS p4 <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - y a <br /> Storage Location Casing type <br /> Blank fL Screen Z S ft. <br /> SIot size 12TO <br /> GROUTING Bags cem <br /> Buck cntonit <br /> Depth to water Bags vel -=--? <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: y/ n ) <br /> Quantity Installed Discussed wit geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />