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JNITORING WELL INSTALLATION REPO. <br /> Date: /0/3/01' CONSTRUCTION <br /> Premise Address:.8 Total Depth �v <br /> f Screen Length (from) (to) <br /> Well No.: M O±A_ , & '4!l ►�44 t.o""-' Filter Pack (from) (to <br /> Bentonite (from) (to)�� <br /> Inspector: Grout (fro ) UI (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 41F I.D. <br /> s<� / Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: W <br /> Driller: casing <br /> height <br /> Consultant �aA�� � , <br /> Geologist d-f •- T <br /> ABOVE-GROUND C4_SLM4= <br /> OOMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suriac4 <br /> Distance to sewer line Gf0ut <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - tt. <br /> 4n. <br /> _ <br /> = m <br /> 0 <br /> SAMPLINGslotted <br /> NCA = c <br /> wc5an _ <br /> Holding Temperaturegrava= Pack <br /> Method _— <br /> Screening Method <br /> Tracking Sheet ( y/ n ) _ <br /> tt. <br /> SPOILS I D 6; <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) n <br /> Storage Location Casing type <br /> Blank yS" ft. Screen Ze ft. <br /> Slot size 0.01 O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 111-L- <br /> Mix <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (Vy / n ) <br /> Type of method <br /> EH 29 29 <br />