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*%'%IONITORING WELL INSTALLATION REPO <br /> Date: y� �G C CONSTRUCTION <br /> Premise Address: Total Depth 75 <br /> Screen Length (from)____7y.9 (to) ro9 8 <br /> Well No.: Zv 1&&JZ3 Filter Pack (from) (to) <br /> Bentonite (from) 6K (to) (,*, . <br /> Inspector: « Grout (from) !. .> (to) O <br /> Drilling rig type &4S <br /> Permit No. o� 7Sa < Auger O.D. ff I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �/� <br /> Driller: � /N1&e2/ w casing <br /> height <br /> Consultant^/ <br /> Geologist <br /> ABOVE•GACUND <br /> COMPLETION CNAISTY-BOX <br /> PLETI <br /> SPECIAL PERMIT INFO. Ground Surtan <br /> Distance to sewer line � �r I�a oroul 1 <br /> Domestic well on site - (y n U �,rrte�• G3 <br /> If yes, location and distance - 72Zl, CC ft. <br /> %P = <br /> SAMPLING sloitod = c <br /> soc5on <br /> Holding Temperature /NA4r_ & b� <br /> gi vi pack <br /> MethodLJ <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) r _ <br /> SPOILS 'f- / <br /> Storage Meth �od v5 (J C/ti� /Y� MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) 2.i D�n <br /> Storage Location 4AP011 'i4. _ Casing type r l <br /> Blank M1 ft. Screen <br /> Slot size oto <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 2 <br /> Mix Ratios = Filter Pack type/size <br /> Installation Method t'C;8O"'W ffs Surge Block: - (y/ n ) <br /> Quantity Installed —� Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 9 <br /> ��Cc 3 <br />