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*ONITORING WELL INSTALLATION REPO <br /> P02- <br /> Dale: f� <br /> // by CONSTRUCTION <br /> r <br /> Premise Address: LI25 S'_ �c 4 Total Depth IV •J <br /> Screen Length (from) (to) r_ <br /> Well No.: !�- Z1i Filter Pack (from) �Q.�7 (to) <br /> Bentonite (from) (to) . <br /> Inspector: Grout (from) 8 (to) A <br /> C Drilling rig type <br /> Permit No. Auger O.D. I c C I.D. <br /> Completion - S ove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �� 3 casing <br /> height <br /> Consultant <br /> Geologist «/ ^ ``� <br /> A$OVN <br /> COMPLETIOLE(ION `8 CNRZTY-BOX <br /> OMPLEMN <br /> SPECIAL PERMIT INFO. nd Surf <br /> itn0� <br /> 9 Cuwc proof <br /> Distance to sewer line -n <br /> Domestic well on site - (y <br /> If yes, location and distance - '' //,,GG n- <br /> .�1n. r< _ <br /> O <br /> - C <br /> SAMPLING slatted = ' c <br /> seclon S <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> Jn, <br /> SPOILS <br /> Storage Method 4 �"' ^ �- / MATERIALS/DEVELOPMENT <br /> Contamination Noted - (n ) i( S� 9� eve <br /> Storage Location Casing type <br /> r L ft <br /> Blank . Screen -- ft- <br /> Sl size X10 r� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water "' 30 Bags sand/gravel <br /> r Z3 7 Filter Pack type/size <br /> Mix Ratios 2 <br /> installation Surge Block: - (y/ n <br /> Met ) <br /> Quantity Installed + 7 + Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br /> /d1Z 10?- -Jl ZZ <br /> ce <br />