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IRONITORING WELL INSTALLATION REPOT <br /> Date: "1� ��1 l I U�71iHIA� CONSTRUCTION ��++ <br /> Premise Address: , Total Depth l <br /> Screen Length (from) <br /> Well No.: Ul I b Filter Pack (from) <br /> / Bentonite (from) 17 (to) 4!5L _ <br /> Inspector: Grout (from) 4 S (to) I <br /> Drilling rig type <br /> Permit No. Z '� Z- Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> S(Rl <br /> Driller: V casing <br /> �f <br /> f, �,�/ •� height <br /> Consultant S�a,,IK�I� V <br /> 11 <br /> Geologist� �. •- <br /> 4n�(E sc, a+t vt� / <br /> /180VEGACUND 4ZTY•B0X <br /> COMPLETION COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground S�ctacs -r <br /> Distance to sewer line Qfaft <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - / ft <br /> — SP <br /> = m <br /> a <br /> = o <br /> r <br /> SAMPLING <br /> O �� suc'icn _ Gf <br /> Holding Temperature W� = yravdpadc <br /> Method _ <br /> Screening Method rr = S <br /> Tracking Sheet - / n ) — <br /> �ft. — 1 M <br /> SPOILS c. A <br /> � gg qq 1. <br /> Storage Method r MATERIALS/DEVE OP/MEN l <br /> Contamination Noted • / n ) `-�Q� N �� <br /> Storage Location tl r :$ILr Casing type�� 4f) Nt/- Z __ <br /> Blank '1S ft. Screen h. <br /> 1 Slot size n • b>c-' <br /> GROUTING Bags cement <br /> �1 �^,I' 1 Buckets bentonite uaL <br /> Depth to water ��'� It7 �'� Bags sand/gravel <br /> Mix Ratios l• Filter Pack type/size <br /> Installation Method 1714row,44 Surge Block: - }5/ n ) <br /> Quantity installed Discussed with geologist: - ( y� n ) <br /> Type of method y0 Vv-II.) <br /> EH 29 29 <br />