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RONITORING WELL INSTALLATION REPOnI <br /> Date: d '2 Z —0 S CONSTRUCTION <br /> Premise Address:(")/7/03 W Total Depth �Z <br /> Screen Length (from) /L (to) 7 <br /> Well No.: /U�(/ 1105,/7 /00s Filter Pack (from) 11— (to) �o <br /> Bentonite (from) (to)� <br /> Inspector: L0. Grout (from)- <br /> Drilling rig type <br /> .D / <br /> Permit No. 7 3 Auger O . I.D. <br /> � � Completion Stove pipe/ hristie box (circle one) <br /> Drilling Company: <br /> Driller: / �' casing <br /> height <br /> Consultant Geologist ` /Z ;73 <br /> T <br /> ABOVE-GROUND CtIA75T 4= <br /> CONFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S ° i��� <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) ? Cc S Al <br /> 1 ft, <br /> If yes, location and distance - 6 ft• <br /> m <br /> = m <br /> SAMPLING / &tatted = <br /> wc5on <br /> Holding Temperature pnval pads <br /> Method = <br /> Screening Method = ;' <br /> Tracking Sheet - (y/ n ) <br /> /Z ft. EEL, ft. <br /> SPOILS <br /> Storage Methods MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2'k Scd. PdC <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size • 07.0" <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water '`"I C) Bags sand/gravel 2— <br /> Mix <br /> Mix Ratios 941 s t 7 kt L Filter Pack type/s;— 1 3 <br /> Installation Method Surge Block: - (y'0 <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br /> g/Z 2`0 <br />