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:.•...x rte.-, <br /> n/iONITORING WELL INSTAILATION REPOnf l <br /> - Date: 2( Zo0 CONSTRUCTION <br /> Premise Address:, l� �! _ Total Depth 3� <br /> Screen Length.(from) (to)— <br /> Well No.: Y Filter Pack (from) (to) <br /> Bentonite (from) a (to) L <br /> Inspector: Grout (from) l0 (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. Fhr <br /> Completion - Stove p' tie box (circle one) <br /> Drilling Company: (i - <br /> 4� casing f <br /> Driller: <br /> 4 h 9 t ti <br /> a� z. �. tet. _�� e i h - <br /> Cpnsultant <br /> Geologist <br /> J1BOVS-GROUND- CtiR6STY-BOX <br /> :':tet . «. ► P <br /> SPECIAL.PERMIT INFO. <br /> Distance to sewer lute - <br /> ''Domestic:well on site - (y16 <br /> If yes, location and distance - <br /> Sm <br /> SAMPLING ° y ' - •lotted ;: _ <br /> Holding Temperatur 4 G lt� _ vel paUc <br /> t <br /> Method <br /> t — <br /> '}tA <br /> Screening Method AAJAW <br /> y "' <br /> Tracking Sheet - n ). � (° <br /> 4 Y ✓ y 1 . S <br /> SPOILS <br /> Storage MATERIALS EVELOPMENT' Y'� ` <br /> Contamination Notjd - n�I � Zrt <br /> Storage Location 0-�,,Z Casing type <br /> t _ Blank f. Screen ft. <br /> Slot size n <br /> GROUTING ' ti - Bags cement <br /> K t: 5' i <br /> Buckets bentonite <br /> t %Depth to waterer i �.- * �'-� .,; ,IlkBags,sand/gravel <br /> Mix Ratios � filter Pack type/ ' e' <br /> In'stallation'-Method' L.+�_' '_" s Surge Block:'-�n ] <br /> "Discu_ssed with geologist: (Y n tl4 - <br /> n Quantitylnstalled' .. <br /> ` Type of medh d V <br /> EH 29f 29 <br />