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ONITORING WELL INSTALLATION REP* <br /> Date: b I L� I ( / CONSTRUCTIO <br /> Premise Address: 19T(5;- M^ 4Z - Total Depth Z s <br /> Screen Length ( om) / (to) Z <br /> Well No.: nS— C9 SZ A- O Filter Pack (I rom) /'i (to)T <br /> Bentonite om) I I (to)_J Z <br /> Inspector: Grout Worn) pL`_(to) 1 f <br /> Drilling rig type <br /> Permit No. L?/�s3 Auger O.D. I.D. <br /> Completion- St ve pipe/christie box (circle one) <br /> Drilling Company: \13,1. <br /> casing <br /> Driller: �^^�L INT <br /> height <br /> Consultant��'C' <br /> 1 <br /> tY <br /> Geologist_ ABOVE-GROUND <br /> COWLETION CMPLET <br /> COMQLEIJON-Ground <br /> _ . <br /> SPECIAL PERMIT INFO. Su tx+ � <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - n ) ft. <br /> If yes, location and ce - ft. <br /> — m <br /> - q <br /> _ O <br /> - C <br /> = O <br /> SAMPLING stomv; <br /> Holding Temperature <br /> Method •— <br /> Screening Method n . <br /> Tracking Sheet ( / n) _ <br /> SPOILS <br /> Storage Method mATERIALSZ2 VELOPMENT <br /> Contamination Noted - (yY'n ) ev <br /> Le <br /> Storage Location Casing type <br /> Blank ft. Screen-------LO—ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bento e <br /> Depth to water Bags sand/grav 1 N 3 <br /> Mix Ratios 0(%f l Filter Pack type size 2 Vvl ^" <br /> 99 <br /> Installation Method _ Surge Block: - y <br /> Quantity Installed /�� �� r. / Discussed with eolvogist: - (y <br /> _Lr_ Type of method <br /> EH 29 29 <br /> ('12,7170a 0 <br />