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„..,)NITORING WELL INSTALLATION REPC:,.... <br /> Date: C Z (e12 CONSTRUCTION <br /> Premise Address: y t -"�`"� Total Depth �6 <br /> Screen Length (from) 5'S (to) Ss ' <br /> Well No.: I Filter Pack (from) 9%fz (to) 5-3-y' <br /> A (� Bentonite (from) �65' _(to <br /> Inspector: N G Tl Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ` <br /> �r <br /> Driller: �—'°"”` �_- 'CjQ/��U� casing <br /> _ height <br /> Consultant GT-- <br /> Geologisty e <br /> ABOVE-GROUND CtiRI.STY-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf acs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 1 ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> _ o <br /> SAMPLING slottad t <br /> sadon <br /> Holding Temperature y✓ f°�� �t" �f <br /> Method = ��Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. = ft, <br /> SPOILS <br /> Storage Method 441 P14,411- Skcef �z�`v� �`'c Co7w� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> rhe-,yttta(-�✓� �� Blank ft. Screen ft <br /> -IS'/6 701/0a "4 Slot size <br /> GROUTING Bags cement ( <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29 <br />