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MONITORING WELL INSTALLATION REPOec C <br /> Date�.?u �/� g CONSTRUCTION <br /> Premise Address: �® � W- Yq Total Depth <br /> Well No.: Screen Length (from) go (to) 0 <br /> Filter Pack (from) SO (to) <br /> Bentonite (from (to) 3 <br /> Inspector: t-t Grout (from) (to) O <br /> /y� ry/ Drilling rig type_ Giu E <br /> Permit NO. 7 T�d b Auger O.D. I.D. <br /> Drilling om <br /> nQ p Completion - Stove pipe/christie box (circle one) <br /> Cany: / CP <br /> �� ,�pp L L ii-- <br /> Driller: �GOC�� —�^�""'� V <br /> casing <br /> p�G height <br /> Consultant � �dA ,/ <br /> Geologist I/GTax Ai�IrPiC� — T <br /> ABOVE-GFIOUND <br /> COMPLETION /S~ C-RISTY-BOX <br /> SPECIAL PERMIT INFO. Grourd Surf OtAPLETIO <br /> g�"nD 5 + ' <br /> Distance to sewer line '� grout 3 <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 3� <br /> = o <br /> SAMPLING <br /> slotted <br /> s+cdon = <br /> Holding Temperature <br /> Method = vawl pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> _ n. <br /> SPOILS oil <br /> Storage Method MATERIALS/DEVELOPMENT �r6b <br /> Contamination Noted - (y/ n ) ObAle {� O-i3S r�^ 8i�i �r jQ <br /> Storage Location Casing type �' <br /> Blank 90 ft. Screen ft. <br /> Slot size O/V <br /> GROUTING Bags cement S�7 t _ <br /> Buckets bentonite 3 <br /> Depth to water Bags sand/gravel <br /> Mix Rados Filter Pack type/size l iZ - <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> evli3/fib ���u/-9l <br />