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,..oNITORING WELL INSTALLATION REPOI,,w <br /> 2 Date:1_j CONSTRUCTION <br /> Premise Address: A_f q;O CSM 14 t 7 Total Depth 3 <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type C M r% 56 <br /> Permit No. � d ��� Auger O.D. 73 %gJ I.D. y j[ <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: nn �ja� �,, casing <br /> r� n <br /> Consultant lV height <br /> Geologist (�LZ �)°�L� Rpth �►�Pf"" <br /> AEZV -GRCUND <br /> 5 COMPlET10N CCCMPPLETION <br /> SPECIAL PERMIT INFO. (�� Ground Surface <br /> Distance to sewer line N ��' 15 L grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance -�µwq 5 fi. <br /> 1 o 2 <br /> D5 - <br /> SAMPLING <br /> when 3 <br /> Holding Temperature_ <br /> Method 5 .a. = Ifivw pa-* <br /> Screening Method — <br /> Tracking Sheet - {�y! n ) <br /> SPOILS <br /> Storage Method OYI V 4 6tZVA— MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ I?V c' <br /> Storage Location -5 Casing type <br /> Blank 10 ft. Screen <br /> Slot size 6 Zb <br /> GROUTING ' Bags cement <br /> Buckets bentonite l S-ti <br /> Depth to water Bags sand/gravel Ce '/2� ba C 5 <br /> Mix Ratios q l f1 Filter Pack type/size ' 3 <br /> Installation Method Vbvrtd Surge Block: - (P ti) <br /> Quantity Installed Iq 40 Discussed with geologist: - (y/ n ) <br /> Type of method W t Lai <br /> EH 29 29 <br /> x,00 � <br />