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i <br /> NITORING WELL INSTALLATION REPOI <br /> Date: CONSTRUCTION <br /> Premise Address: �� z 1,6 Total Depth <br /> Screen Length (from) (to) _ <br /> Well No.: Filter Pack (from) 33 (to) !s _ <br /> � Bentonite (frons) 1�t (to) <br /> Inspector: Grout (from)_ L.?` (to) f- c� <br /> % —` Drilling rig type <br /> Permit No. i � Auger O.D. I.D. _IV Ac ' <br /> 7-1 <br /> Completion - Stove pip Trestle ox circle one) <br /> Drilling Company: E1 <br /> Drille �? oasinq <br /> height <br /> Consultant ,irlua�4z <br /> Geologist_ ABOVE-GRCUND CHRlS 43OX <br /> i COMPLETION y COMPLET1CN <br /> SPECIAL PERMIT INFO. - e=rwrd ser! <br /> Distance to sewer line Qraut <br /> Domestic well on site - (y/ n } �.ft. ' <br /> If yes, Iocation and distance - ft. , <br /> —is—ft. _ <br /> SAMPLING tiatted <br /> socicn <br /> Holding Temperature <br /> Method � ' _ v"w Pa <br /> Screening Me otK d_ t9°� <br /> Tracking Sheet n ) f :; <br /> �} ti. w " <br /> ft. <br /> i <br /> SPOILS <br /> i� <br /> Storage Method a 3 MATERIALS/DEVELOPMENT <br /> Contamination N(Sted / n ) ? <br /> Storage Location. 04_ Casing type _ <br /> BIank /4P ft. Screen fS" ft. <br /> i Slot size 0- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to mater ! 2:3 l Bags sand/gravel #,2 L.o�� .9✓ <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method ° r Surge Block: - (y 410 <br /> Quantity Installed Discussed with geologist: n)' <br /> Type of method <br /> EH 29 29 ». <br /> i .i <br />