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Q,C}NITORING WELL INSTALLATION REPO <br /> Date: L� ?• I�Z CONSTRUCTION <br /> Premise Address: S Total,Depthl <br /> Screen Length (from) 70 (to) �5 <br /> Well No. 13 r 3 Filter;;Pack (from) (to) 83 <br /> Bent6hite ;1� (from) 33 (to) 3.0 <br /> Inspector. Grout .� (from)_ 3.0 (to)_ <br /> �-' Drille C5 <br /> ing rig <br /> Permit No. Auger O.D.-1i II S I II,2 l• <br /> COI IIetion''- Stove pip Christie bo (circle one) <br /> Drilling Company:_ <br /> I' i! <br /> Driller: casing <br /> height: <br /> Consultant <br /> Geologist. �Oe' <br /> _ i17. <br /> ABOVE-GRCUND a <br /> CO&OLETiON Cid MIry-8GX <br /> i� COMPLE ON <br /> SPECIAL PERMIT INFO, Ground SwIfaca <br /> Distance to sewer line N!� g(cut <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - <br /> Y. p C <br /> i wc' <br /> SAMPLING f u <br /> sackn —_ <br /> Holding Temperature <br /> Method I ' — QMVW Fag* <br /> Screening Method <br /> Wracking Sheet - On ) j <br /> SPOILS ,. <br /> n ,zl <br /> Storage Method MATER1612EVEI,OPMENT <br /> Contamination Noted - y ) i. A <br /> Storage Location Cv Casing type Z 1 eqL. <br /> 4 Blank] ii ft. Screen ft. <br /> ` Slot size :il d.d2n <br /> GROUTINGI, <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Packtype/size <br /> Installation Method Surge:Block: (y <br /> Quantity Installed Discussed with geologist: - y <br /> Type of method <br />' EH 29 29 <br /> VIA 14ay. I <br />