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4"NITORING WELL INSTALLATION REPO'',! <br /> Date: �y� CONSTRUCTION <br /> Premise Address: 6e44drJ Total Depth �5 <br /> / Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) . 1 <br /> ' I Bentonite (from) (to) <br /> Inspector: /�n Grout (from) 40) (to) <br /> Drilling rig type -d I <br /> Permit No. Auger O.D. f Yt� LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �� • � � . <br /> Driller: casing <br /> height <br /> Consultant T <br /> Geologist ABOVE-GROUND T <br /> COMPLETION CHRMTY4= <br /> COMPLETI <br /> SPECIAL PERMIT INFO, Ground S <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y 4l tt. <br /> If yes, location and distance - i/� tt u6 s tt <br /> = c <br /> _ o <br /> SAMPLING slotted = $ <br /> sscdon — <br /> HoldingTem erature UCi _ Gn+ dP <br /> Method A Gw --7,4&L. o <br /> Screening Method 0 TD <br /> Tracking Sheet - 0/ n ) <br /> tL <br /> SPOILS <br /> Storage MethodN �/ A MATERIALS/DEVELOPMENT <br /> Contamination oted - ( y ) ✓/C/ <br /> Storage Location /l1 Casing type <br /> Blank ft. Screen_ _ 2 y ft. <br /> Slot size 62. 6 <br /> GROUTING Bags cement <br /> r Buckets bentonite_ 7S . <br /> Depth to water S Bags sand/gravel <br /> Mix Ratios &L vF re_ ti. e,.,.T w / r 2 / ti Filter Pack type/size .r <br /> Installation Method 7t2At4l Surge Block: - ( y 111A <br /> Quantity Installed Discussed with geo ogist: <br /> Type of method <br />