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IqONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address:_ 1 '�V — Total Depth ?i <br /> Screen Length (from) 1_ (to) <br /> Well No.: 1U\W 'q7 Filter Pack (from) 1; (to) 3 O <br /> Bentonite (from) t\ (to).i <br /> Inspector. I1��\I, Grout (from) k t (to) t <br /> Drilling rig type <br /> Permit No. 3Z 3 Auger O.D. I.D. 4 AL <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �%A<J r casing <br /> T height <br /> Consultant �J((111�N�n ` T <br /> Geologist --L1kvr, RC1 T <br /> A80VE-GRCQND CF6i M-Box <br /> COMPLETION COMP <br /> SPECIAL PERMIT INFO. c1ro+r+d Surtax <br /> Grout <br /> Distance to sewer line I ' <br /> Domestic well on site - (y/ n) _7!�_ft. <br /> If yes, location and distance - J4ft. ft. <br /> a <br /> 0 <br /> = o <br /> SAMPLING 152� 3D doral _ 2 <br /> I 1 aacicn — <br /> Holding Temperature /-)00. = Gravel pads <br /> Method__ <br /> Screening Method <br /> Tracking Sheet - y n ) <br /> SPOILS 1 Q <br /> Storage Method Si7ii />� MATERIALS/DEVELOPMENT <br /> Contamination Noted • n ) Pl1>-/l0 PA Iy"16�A ` —D <br /> Storage Location Casing type <br /> Blank ft. Screen fr• <br /> slot size n •0717 <br /> GROUTING Bags cement <br /> 1 Buckets bentonite <br /> Depth to water ) Bags sand/gravel <br /> Mix Ratios 5 l L Filter Pack type/size <br /> Installation Method Surge Block: - (y( n ) <br /> Quantity Installed ISOAo Discussed with geologist:- n) <br /> Type of method <br /> EH 29 29 <br />