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-,.,40NITORING WELL INSTALLATION REPO-_. <br /> Trick r1 + <br /> Date: Z/ 2oo CONSTRUCTION Gp <br /> F. <br /> j /�� ��" ✓7' J 3f <br /> Premise Address: Total Depth yz c �w <br /> /� rr Screen Length (from) (to) <br /> Well No.: /`/ ° 1 Yl�r/�Cy� NAY 11 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Il��(�1� l�.''`"r i� y,,/1s d�✓,�/cs Sc k)ljl ,f Grout (from) (to) <br /> Drilling rig type d lv�' <br /> Permit No. <br /> rj �j rJ Auger O.D. • "i I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: / y ��, J�P' <br /> Driller: C�/ w►c�+t casing <br /> �,/ height <br /> Consultant I Te-e- i'h < <br /> Geologist t/� V=�S A8-C E-GROUND <br /> COlvi'r'LEi ION Ct{R15TY 80X <br /> COMPLETICN <br /> nd <br /> SPECIAL PERMIT INFO. Surface <br /> Y-ti q i✓ c+.+ ed- grout <br /> Distance to sewer line I S+ ,rf Vq(&qp1 -Ile-445- <br /> Domestic <br /> %-445Domestic well on site - (y/ n) �L �+-rtvv7N�iYw.�-• ft. <br /> If yes, location and distance - <br /> tef, <br /> ft. <br /> -2 nJ G✓ref �kN� :>:.:. = z j `= �i'�/ <br /> m _ <br /> C M ix <br /> SAMPLING slotted _ V ll r+/a- 6- <br /> aacction <br /> Holding Temperature _ VI"W Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blankiz �ft- <br /> ScreenSlot s <br /> GROUTING Bags cement H�•i it! - <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Methorl Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />