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iVI� OITORING WELL INSTALLATION REPOMI`rr►, . <br /> J <br /> Zoo¢ CONSTRUCTION <br /> Date: <br /> fib/ Z �� � . D Total Depth (to) <br /> Premise Address: Screen Length (from) <br /> / Filter Pack (from) (to) '�--- <br /> Well No.: Bentonite (from) Z (to) 3a <br /> Grout (from) 30 (to) o <br /> Inspector: Drilling rig type 'E S <br /> �n Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> � casing <br /> ON� � <br /> Driller: height <br /> Consultant l -G` �► <br /> ASOYE-GROUND <br /> Geologist CHAtSiY-80X <br /> 16/ COMPLETION COMPLETION <br /> ' Ground Surface <br /> SPECIAL PERMIT INFO- <br /> O proof <br /> Distance to sewer line lo - ft. <br /> Domestic well on site - (y'V y ft. <br /> If yes, location and distance - ft. <br /> CIS <br /> •= c <br /> slotted is C <br /> SAMPLINGsection <br /> =_ <br /> Q <br /> Holding Temperature / VC <br /> = S Pack <br /> Method " <br /> Screening Method <br /> Tracking Sheet -6pn) <br /> SPOILS / <br /> Storage Method7 MATERIALS/DEVELOPMENT Q <br /> Contamination Noted - (yn ��r � T✓� <br /> Storage Location Casing type <br /> Blank 35 ft. Screen-2p—ft. <br /> Slot size -� <br /> GROUTING Bags cement <br /> Buckets bentonite l � <br /> .� Bags sand/gravel <br /> Depth to water a <br /> Mix Ratios Filter Pack type/size 3 <br /> T � t 7F / - ' <br /> Surge Block: - (y <br /> Installation Method -s!.�%�� n� <br /> � Discussed with geologist: - (yam <br /> Quantity Installed //0 <br /> Type of method <br /> EH 29 29 <br /> ZOO <br />