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s"fACNITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCI'ION 2 <br /> Premise Address:_ 27177 ///t. Total Depth 37 <br /> Well No.: �J Screen LeFilter Pack (from) '� (to) ? ' <br /> (from) 3 - (to) 2-5 <br /> Inspector: 'L <br /> Bentonite () (to)2� Z <br /> 10 <br /> Grout0 <br /> J�IZ 5y�7 Z Drilling rig type - - Z_ <br /> Permit No. Auger O.D. 15 I.D. <br /> Drilling <br /> Completion -Stove pipe/christie box (circle one) <br /> Comp//any:�� C�-C�/ <br /> Driller: (lZlu' 7/o��fi casing <br /> s /�e height <br /> Consultant ���/ <br /> � <br /> Geologist <br /> ABOVE-GROUND (tY430X <br /> OOAFLETX)N <br /> 9 <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line ASO grout <br /> Domestic well on site - (y(CD l3 <br /> If yes, location and distance - ZS ft' <br /> Z� ft. is ft. <br /> �Y.. - <br /> 'v'' � m <br /> O <br /> C <br /> SAMPLING doted __ c <br /> Q� wclon = <br /> Holding Temp tore / _ gravel Pack <br /> Method ? <br /> Screening Method �r O✓�`- 3 <br /> Tracking Sheet (y n ) 37 <br /> ft. — ft. <br /> SPOILS <br /> Storage Method '3.5gm-t �` s MATERIALS/DEVELOPMENT <br /> Contamination Noted - 0 n ) <br /> Storage Location . A-A Casing <br /> /etype / <br /> Blank ?�7 ft. Screen ft. <br /> Slot size ' 0/0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel s 40 <br /> Mix Ratios �f� Y Filter Pack type/size /z, <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />