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NITORING WELL 1NSTALLATION]-REPOfj <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth iF <br /> 5creeA Length (from) S (to) G� <br /> Well No.: ���T Filter'Pack (from) �T� (to) <br /> Bent2 to , (from)___.P_4 _(to) � <br /> Inspector. ��� Grout ;; (from) (to) <br /> Drilling rig type <br /> Permit No. Augerl,O.D. :a n D. " <br /> Completion = Stove pip chnstie ox a one) <br /> Drilling Company: :f <br /> r Driller. casing <br /> 7 "he;ght <br /> Consultant u/� <br /> Geologist lof�'Jf�d3 n 6 <br /> A3CVE-GRCUNO C�f.SIY-r30X <br /> COhiPL.�T10N CpWJ'1_= 1CN <br /> SPECIAL PERMIT INFO. ! ! Ground Surfws <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) (n <br /> If yes, location and distance - It- <br /> s <br /> �h 1 <br /> IP ! <br /> SAMPLING <br /> cn <br /> Holding Temperature G ��Yrp� .w <br /> ack <br /> Method �'VOI" <br /> Screenin;Method it 4 <br /> Tracking Sheet - (y/ n) — <br /> �, 1 <br /> fir <br /> SPOILS { <br /> ' Y <br /> Storage Method MATERIALS%DEVELOPMENT <br /> Contamination Nozed - n } rl A16Storage Location__0 _ �r Casing type _ <br /> ,rte Blank! JWft. Screen 2D fL <br /> �b7^ ��o�p✓yl �� r- Slot size -! t;a - - <br /> GRO[J'i'iNG f b Bags cement) <br /> �►�7 Buckets bcniflnire - e- T4 , <br /> Depth to water cd iBags '3and/gravel—�_2 <br /> Mix Ratios Filter Pack type <br /> Installation Method Surge'lBIock: -� n) <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of meslod <br /> EH 29 29 �_ 1 <br />