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ItONITORING WELL INSTALLATION REPO <br /> i <br /> Date: / Z 00 CON515doON <br /> „i <br /> Premise Address: 4700 ( nk A51y" {2a Total Depth�/yv <br /> Screen Length (from) )-j2 _(to) ! <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)—(to)— <br /> Inspector Grout (from) (to) <br /> Drilling rig type <br /> Permit No. // Auger O.D. I.D. <br /> Drilling Company:_ <br /> Lu�v� V" S G+tS Completion - Stove pipe/cltristie box (circle one) <br /> Driller: casing <br /> 1711 <br /> heightConsultant p--Geologist > ���"Siu r <br /> ABOVE-GACUND —a <br /> COMPLETION Ct4i M-SOX <br /> SPECIAL PERMIT INFO. G=nd COMPLETiCN g�y�y <br /> Distance to sewer line 6-'A- proof <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> SAMPLING 3 <br /> Aloroi _ — *a <br /> tacicn <br /> Holding Temperature <br /> Method _ = pravalyatlt <br /> Screening Method r^ <br /> Tracking Sheet - (y/ n ) _ <br /> �0 tt. V <br /> = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) it <br /> Storage Location Casing type F",/ <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />