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NITORING WELL INSTALLATION REPOF <br /> Date: 3 "�s CONSTRUCTION <br /> Premise Address:_S C �Fc1J�P` Total Depth <br /> Screen Length (from) 1 Q (to) <br /> Well No.: MUJ' Filter Pack (from)_(60 (to) 3 <br /> Bentonite (from) ")S (to) <br /> Inspector: a��J Grout (from) '),') (to)l_ <br /> Drilling rig type GVI �S � r <br /> Permit No. O 5333 Auger O.D., l� I.D. Z lb <br /> Completion - Stove pip s ie (circle one) <br /> Drilling Company: <br /> Driller: I <br /> � height <br /> T casing <br /> t <br /> Consultant �, � <br /> Geologist 9--Ua,IZ,4 /�C-k-PajJ 7EWT <br /> ABOVE GACUND <br /> CX <br /> CC&FLFr1CN COMPLE--8CN <br /> COMPL":^T1CN <br /> SPECIAL PERMIT INFO. Ground Surfsca T '' <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) 12L—ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> — o <br /> - C <br /> O <br /> SAMPLING slatted — <br /> sacson —' <br /> �J l — <br /> Holding Temperature i — gra,rel pads <br /> Method <br /> Screening MethodL __ <br /> Tracking Sheet -)T n <br /> SPOILS <br /> Storage Method li'�� 1 )�1 �1�1 EYl �D MATERIALS/DEVELOPMENT <br /> Contamination Noted y n ) <br /> Storage Location h L) Casing type <br /> h� Blank 4A) ft. Screen 2 <br /> Slot size -n - DU <br /> GROUTING S 51l' ags cement <�AA <br /> i R uckets ntonite � <br /> Orn, -Cj� B gs san gravel <br /> Depth to water � (W <br /> Mix Ratios F' er <br /> -Pack type/size <br /> Installation Method 'CW--mmaL ffU' ! 'S ge Block: ) <br /> Quantity Installed toeDiscussed with geologist: - (�nn ) <br /> Type of method ')M 1 <br /> EH 29 29 <br />