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ITORING WELL ?NS7AL1.Ai?ON RH-DORT- <br /> Date: T" nn// CONSTRUCTION <br /> Premise Address: 7�� ar ati"-&' Total Depth <br /> �� Screen Length (from) SS. $ (to) 35.5 <br /> Well No.:_ /M^/ ) S Filter Pack (from) 55.5 (to) 33 d <br /> / Bentonite (from) 33. (to) <br /> Inspector: � """� Grout (from) (to) <br /> Drilling rig type B-la/ <br /> Permit No. Z-0 g3?� Auger O.D. /D 3 I.D. <br /> �� � Completion - Stove pipe/christie bo (circle one)' <br /> Drilling Company: <br /> casing <br /> Driller. � r77T height <br /> U T <br /> Consultant '4m� 4L6)0 — <br /> Geologist C ��D���� ABCVE•GAWND <br /> OCNFL?TICN CFiA1STl 3CX- <br /> CCMPLETICN <br /> Cxound Sufis <br /> SPECIAi PERMIT INFO. <br /> Pratt <br /> Distance to sewer line. 50 <br /> Domestic well on site • (y/no -" 56.7 ' <br /> If.yes, location and distance - D tL <br /> �.trctt r:y <br /> � � O <br /> SAMPLING an <br /> ry <br /> Holding Temperature <br /> Method Screening Method <br /> Tracking Sheer' - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted • W n ) /Gd—/6 rf c 1A ��C <br /> Storage Location Casing type 1 <br /> Blank---3L.fift. Screen--:?LO ft. <br /> Slot size .02-- <br /> GROUTING <br /> OZGROUTING Bags cement <br /> 2 Buckets bentonite - <br /> Depth to water ✓ Bags sand/gravel 16 <br /> Mix Rados ?9 Filter Pack type/size <br /> Installation Method wi Surge Block: - (y� n ) <br /> Quantity Installed Discussed with geologist: • f©/ n ) <br /> Type of method lsi <br />