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] _ NITORING WELL.INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: 4 Total Depth <br /> Screen Length (from)_ 3 3V (to) <br /> Well No,: r Filter Pack (from)_ q- (to) <br /> Bentonite (from) s�`(to) 3 <br /> Inspector: _ S - Grout (from) (to) <br /> U � � Drilling rig type a <br /> Permit No, �' Auger O.D. er <br /> I Completion - Stove pip Christie box (circle one) <br /> Drilling Compa1ny:� - ��.yll <br /> �.G _y l <br /> Driller: a o9'� ✓1 � caning <br /> <j ,,. // f1 > height <br /> ConsultantWm',ry + CX�I.t/i�✓ '4 <br /> Geologist_ .M. o 46L <br /> ABOVE-GRCUND <br /> COtr LEYION CHRMY$OX <br /> CompLe 7C <br /> SPECIAL PERMIT INFO, G=nd Swfac+ <br /> Distance to sewer line <br /> Domestic well on site - (y/n ) 3 <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> .74 'a <br /> SAMPLING 5IoT*Qd <br /> sedcn <br /> Holding Temperature <br /> Method z m1' IMS JaCK <br /> Screening Method k; <br /> Tracking Sheet - / n ) <br /> Ott. . <br /> SPOILS _ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted •c9ly <br /> Storage Location J Casing type �, _� <br /> Blank ZY— ft. Screen_ ft. <br /> SIot size t 0?_0 <br /> GROUTING Bags cement <br /> Buckets bentonite 3`moo <br /> Depth to water 2v Bags sand/gravel Ccs - <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 <br />