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TONITORING WELL INSTALLATION REPO <br /> Date: 1"UV"'10`� 1 CONSTRUCTION <br /> Premise Address:__ G�/��/� <%� Total Depth z� <br /> Screen Length (from) 3 (to) I if <br /> Well No.: Filter Pack (from) 2 (to)1R <br /> Bentonite' (from) 1�r-Za t' (to) I—Z ' <br /> Inspector: Grout (from) (to) <br /> ,p Drilling rig type l}. <br /> Permit No. ��` SZ( Z Auger O.D.^ <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �. C' 10'10 Grp,� 5 rys9 <br /> Driller: a,w cas ing <br /> height; <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND �iSZY BO?C <br /> OOWFL.E"T;ON COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ nn. <br /> If yes, location and distance - ft <br /> ft. <br /> C <br /> O <br /> SAMPLING siattad <br /> aar�ian <br /> Holding Temperature _ Grave!pad" <br /> Method - _— <br /> Screening Method <br /> Tracking Sheet - (y/ n) a' <br /> ft, ft <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <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 /> C; 'n / , Type of method <br /> EH 29 29 <br />