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Q �j MONITORINGWELL INSTALLATION REPG`i <br /> Date: 1 �ic�� 6? ( �icL/tl ) CONSTRUCTION <br /> Premise Address: �zy0 /t ' Total Depth 6<6 <br /> Well No.: "j) �� Screen Length (from) 3S (to) so <br /> Filter Pack (from) (to) E <br /> Bentonite (from) 3 (to) 3 <br /> Inspector: Grout <br /> (from) -JJ'I inL <br /> (to) t <br /> OD��� � Drilling rig type .[ 10—k 1 <br /> Permit No. ] Auger O.D. /D" I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> 4.r.� <br /> Driller: casing <br /> � / <br /> Consultant ( -- �y!/kj 4�—ee height <br /> Geologist G� U' _ T <br /> lam- ' PD ASOVPLEr;OND CHRISfY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surla� <br /> Distance to sewer line ? "rout <br /> Domestic well on site - (yn <br /> If yes, location and distance 196 ft• <br /> ve'e'� = Ped vo ` <br /> — m <br /> — o <br /> = m <br /> SAMPLING s <br /> i' <br /> slotted = S <br /> uc6on — <br /> Holding Temperature = P <br /> Method — <br /> aCK <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) 41 <br /> ft. ft. <br /> SPOILS ��oo� , <br /> Storage Method /� dcte'l MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) a / e _ `7 Q p <br /> Storage Location Casing type <br /> Blank 35 ft. Screen 15 fr. <br /> 2. <br /> Slot size 00' <br /> GROUTING Bags cement I/it <br /> �J Buckets bentonite .ex <br /> Depth to water i7/ ( / Segs sand/gravel <br /> Mix Ratios T 11, 97.aa— Filter Pack type/size 3 <br /> Installation Metho Surge Block: -(Y�jn ) <br /> Quantity Installed YS SS r Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />