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�NITORING WELL INSTALLATION REPO. <br /> Date: h l g'9� CONSTRUCTION <br /> Premise Address: / Total Depth Z� <br /> Well No.: /�1L�/ S Screen Length (from) 2's {to) t 6 <br /> Filter Pack (from) 2,5 <br /> Inspector: Bentonite (from)_ _�._(to) 1f <br /> P Grout (from) (to) c3 <br /> 9 r`2 Drilling rig type 2 <br /> Permit No.__ l' / - Auger O.D. !O` LD._ 7Af _ <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �J F <br /> Driller: <br /> � , casing <br /> height: <br /> Consultant � <br /> Geologist � G ABOVE-GROUND <br /> COMPLETION <br /> CHRIM43OX <br /> OMPLION <br /> SPECIAL PERMIT INFO. Ground 5LO'Ot <br /> Distance to sewer line >50 <br /> grout <br /> Domestic well on site - (y 45Dn, <br /> If yes, location and distance - <br /> m <br /> — a <br /> C <br /> O <br /> SAMPLING slotted ;• <br /> vection x,. — <br /> Holding Temperature Im+lw Pack <br /> Method <br /> Screening Method I� _ <br /> Tracking Sheet - y n } z� —ft. <br /> SPOILS <br /> Storage Method__ 5 (�...-- MATERIALS/DEVELOPMENT <br /> Contamination Noted -ax n ) (f <br /> Storage Location A-1-2 Casing type Y s -k '6' V <br /> Blank 10 ft. Screen 1 ft. <br /> Slot size <br /> GROUTING Bags cement 3 _ <br /> Buckets bentonite__ <br /> Depth to water 6 Bags sand/gravel <br /> Mix Ratios t fi 7`2 Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> (�- (?-v <br />