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i, rNITORING WELL INSTALLATION REPOI%.d <br /> Date: zP CONSTRUCTION <br /> Premise Address: Total Depth Ta <br /> Screen Length (from) 20 (to) 65- <br /> Well No.: Filter Pack (from) crt> (to) ,LZ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) �f {m} .r <br /> �j Drilling rig type <br /> Permit No. Auger O.D. & +� I.D. <br /> Completion - Cove pip u�stle box ircle one) <br /> Drilling Company: <br /> r <br /> Driller: cas Ing _r.. <br /> he Light <br /> Consultant ' � }j(_`S v '4 <br /> Geologist MAVI. 1;p& <br /> .>._._. 7//, <br /> AWYE{RCUND <br /> COWL_ETION Ct¢it5tY�OX <br /> STI <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) _.�f ft. <br /> If yes, location and distance - �. <br /> SAMPLING ? o <br /> soon <br /> Holding Temperature <br /> Method- __ ¢11°iPack <br /> Screening Method <br /> Tracking Sheet • ( y/ n ) <br /> SPOILS <br /> Storage Method d MATERIALS/DEVELOPMENT <br /> Contamination Woredc ,(Ygr- <br /> Cr <br /> Storage Location Casing type <br /> Blank fL Screen Z3' fL <br /> Slot size <br /> GROLMNG Bags cement <br /> � ✓ Buckets bentonite <br /> Depth to water_, Bags sand/gravel <br /> Mix Ratios Filter Pack typey <br /> e <br /> Installation Method Surge Block: - n ) <br /> Quantity Installed_ Discussed with geology �( Y <br /> ) <br /> Type of method <br /> EH 29 29 <br />