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')NITORING WELL INSTALLATION REPO <br /> Date:TIR I CONSTRUCTION <br /> i <br /> Premise Address: x/07 at4& Total Depth & <br /> Screen Length (from) (to) �O <br /> Well No.: /U'EU �� fLt Zn� /�f I[F� &4TA�t df- Filter Pack (from) D _(to) / <br /> Bentonite (from) (to) 7, <br /> Inspector: Aj 1c:�( Grout (from) /Z (to)��� <br /> �r r�� w! <br /> Drilling rig type <br /> Permit No. � Auger O.D. <br /> Completion - Stove pipe/(!h stie b (circle one) <br /> Drilling Company: S tG <br /> Driller: casing <br /> height <br /> Consultant _%V77F <br /> Geologist bAA.._, ABOVE-GROUND CtiRtSTY-8oX <br /> COMPLETION <br /> COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/qn Z n• <br /> If yes, location and distancn• <br /> a <br /> 0 <br /> SAMPLING section <br /> Holding Temperature o gravel Pack <br /> Method —_ <br /> Screening Method P16 <br /> Tracking Sheet / n ) <br /> SPOILS Q,, <br /> Storage Method AA,,) MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y" fin ) /,11' � <br /> Storage Location ( –„L.�it e Casing type [jL <br /> Blank Z,b ft. Screen 2 G 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 '2 <br /> Installation Method Surge Block: - (y 7ogist- <br /> Quantity Installed / 7 Discussed with geo -0n ) <br /> Type of method <br />