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MONITORING WELL 94STAtt*f!j@N REPG <br /> Date: <br /> CONS.T73UCTION <br /> Premise Address: lf/ L� �� Total iDepth ZS r <br /> Screen Length (from) (to) } <br /> Well No.: Z Filter,IPack ;� (from)_ _(to) <br /> Bentonite (from) (to) <br /> Inspector: <br /> Grouti� (from) (to) ' <br /> Drilling rig type -6/ <br /> Permit No. �" .7 Z .jJq-Auger�O.D. i AW 11 I.D. 63 <br /> Completion "Stove pipe/christie box (circle one) <br /> Drilling Company- <br /> Driller: ,c.�.� I �� casing <br /> .., --- height <br />� I <br />` [rte-t• it <br /> Consultant <br /> Geologist ABOVE-GROUND <br /> COFv PLETION CNRISTY-BOX <br /> COMPLZETION <br /> t_ SPECIAL R..N1IT INFO. y Cirour�d Surixe <br /> Distance to s er Iine <br /> Domestic well site - (y/ n <br /> F a Xle —Iti,If yes, location an distance - ft <br /> 17 <br /> mSA1UtPL%Merh6d Holdinrevavel pack <br /> Method <br /> Screeni _ <br /> Tracking Sheet - ( n )-- <br /> SPOILS <br /> Storage Method `f - - MATERIALS/DEVELOPMENT n� <br /> Contamination Noted - ( y/ n ) <br /> Storage Location dam` ey' " � 'Casing type <br /> Blank I!: ft. Screen €t. <br /> Slot size ;I <br /> GROUTING Bags cement •1: <br /> Buckets°bentonite <br /> �I <br /> Depth to water is 2 Bags sand/gravel <br /> Mix Ratios_ '/ '0" _ s. Filter Pack type/size <br /> Installation MethocT3 Surge Block: -'+( y/ n) <br /> Quantity Installed- 3 E- Discussed with geologist: - ( y/ n ) <br /> Type ofimetho� <br /> - <br /> s <br /> I ... <br /> Jbl' 7- <br /> _ _ <br />