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?ONITORING WELL INSTALLATION REP w <br /> Date: Ci CONSTRUCTION <br /> Premise Address: 1� �.�cL Total Depth Z { <br /> Screen length (from) L (to)!�? <br /> � <br /> WeII No.: W '� W-S Filter Pack (from) ti (to)_ <br /> d Bentonite (from) I' (to) 11 <br /> Inspector. Grout (from) (to) 1, <br /> Drilling rig type <br /> Permit No. Auger O.D. t3 `1 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: c <br /> Driller: §L4 I1q-1 /_�r}4 Q casing <br /> height <br /> ght <br /> Consultant <br /> Geologist <br /> ,E ABOVE•GRCUNO <br /> C�stm-aOX - <br /> CNCOWLEf(ON, ' <br /> SPECIAL PERMIT INFO. G�rour�d Sudwe. <br /> Distance to sewer line S f _ grout <br /> Domestic well on site - (y/ n <br /> If yes, location and distance /p' <br /> SAMPLING <br /> Bored <br /> sedcrt .2 <br /> Holding Tem erature `t 6`,(� <br /> Method <br /> Screening Method 'U v4 <br /> Tracking Sheety/ n ) " <br /> I <br /> 3Z ft. ;r <br /> SPOILS <br /> Storage Method �� �"` �' "S /� MATERJ&I 2 EVELQPMENT• „ <br /> i+ <br /> Contamination Not • (Y/ J� <br /> Storage location. � .Casing type <br /> L (){� <br /> J ; <br /> Blank ! -- ft. Screen_ /,-. ft, <br /> ji Slot sizer 6 Z n <br /> GROUTING Bags cement <br /> Buckets bentonite, <br /> Depth to waterZ-Z, Bags sand/gravel <br /> Mix Ratios_ Cf- Filter Pack type/ 'ze Z 17 <br /> Installation Method^ 3 Surge Block: - } <br /> Quantity Installed 4' 771 Discussed with geologist: - ��/ n) <br /> Type of method <br /> EH 29 29 e <br />