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MONITORING WELL INSTALLATION REPOPoe <br /> a <br /> Date: 5 <br /> 5 ��G CONSTRUCTION <br /> Premise Address: ()� / G- ��/�/Lr 4L/�� Total Depth ?� <br /> Screen Length (from) -Z:Z (to) If 2 <br /> Well No.: /"' /( Filter Pack (from) Z _(to) 1/2 <br /> Bentonite (from) (to) <br /> Inspector: /V G Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> 5 , e / Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: �/ (� <br /> Driller: -84,41- �4LSL'.t -t34 e-ei'oP/y 0_✓5VXV"` casing <br /> height , <br /> Consultant IY <br /> Geologist O oe Alts''/d •- <br /> AE&r:-GROUND CHSZ Y43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft, <br /> ft. <br /> = m <br /> — n <br /> _ <br /> — o <br /> SAMPLING slotted = <br /> section — <br /> Holding Temperature = gmvO pack <br /> Method = <br /> Screening Method ' <br /> Tracking Sheet - (y/ n) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank `2,7 ft. Screen <br /> Aj, S-rJ4 Slot size D1 <br /> GROUTING e--q-; ,Gorr t,�r' �/C Sud zs'SJJ Bags cement <br /> G"'k"/ter-s j�,.� Buckets bentonite VK 0 1'x.1 Ah sky(e I/ , <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 /> 2929 <br /> ethod2929 <br />