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�N1TORiNG WELL INSTALLATION REPG,, r- <br /> �t " <br /> Date:` CD A.7. _ CONSTRUCTION <br /> Premise Address: Total De th b M <br /> Screen ength (from)_ , RU'. (to)_�_ <br /> Well'No.: . . '.�. - <br /> Filter:Pack (ham) 9°O (to) Cfl 3 <br /> BentoniteP1 (from) Q3 -(to) <br /> Inspector. � til S _ . Grout J (from) Gia {to) c� <br /> Drilling rig `type <br /> { Permit No. Auget O.D. 'k �� °� I.D. / <br /> Completion-;- Stove pipe/cluistie box circle one) <br /> Drilling Company: <br /> Driller. L�SS cow A casing s <br /> height' <br /> Consultant 5AI/4 -�- <br /> Geologist s/' d` T <br /> �= ABOVE-GACUNp <br /> «� C04LEMON itOMPt�R3CiV <br /> SPECIAL PERMIT INFO. I a Ground Sul <br /> Distance to sewer line �r0� <br /> ' l �� I <br /> Domestic well on site - {y/ n ) .ft. ! <br /> If yes, location and distance - <br /> JL <br /> ab � • I <br /> SAMPLING . tbrad c <br /> Holding Temperature i GP. ;h _,. _ <br /> MethodL_ _ �,raval Fade <br /> Screening Method .'; LE <br /> Tracking Sheet - / nM <br /> SPOILS 4 <br /> Storage Method 5� MATERIALS%DEVELOPMENT <br /> Contamination Notedd n ) 14 !# <br /> Storage Location_ fi c. �U �" Casing type. 'X6 4' <br /> Blank G ^ fL Screen 9r ft. <br /> Slot size DZ, <br /> GROUTING i Bags cement <br /> Buckets bentonite i <br /> Depth to water CT Bags"sand/ 'gravel 3&2 <br /> Mut Ratios ' = FilteslPack-type e <br /> Installation Me od Surge Block: - y jt ) <br /> Quantity Installed Discussed with eologisr. -� n ) ' <br /> Type;of method <br /> EH 29 29 ii <br />