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.✓iONITORING WELL INSTALLATION REPOn , <br /> r <br /> Date: 5:/-o 8 s 7w6 CONSTRUCTION <br /> Premise Address : 115�� Total Depth Jr/- p <br /> /,�/,' / y� Screen Length (from) Z;:14 (to) Y6 <br /> Well No. : /�/+ // /J Filter Pack (from) a� (to) 53 . 00 <br /> Bentonite (from)-- <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �J/T 0 1/ Auger O.D. LD. <br /> ��© Completion - Stove pipe/ciu-istie box (circle one) <br /> Drilling Company: / — <br /> Driller: � /� casing --`, <br /> _n height <br /> Consultant ��ff� (� <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHRtm-aOX <br /> SPECIAL PERMIT INFO. rd Surf COMPLETION <br /> Distance to sewer �lix� '�' � �� � 0toi1 <br /> Domestic well on site - y n ) Ce 5 $ <br /> If yes, location and distance - ft' <br /> SAMPLING slotted = l_ <br /> �a C or <br /> Holding TemperaturePack <br /> J <br /> Method (xQ —_ 7' <br /> Screening Method �OV/A <br /> Tracking Sheet - ( y n ) <br /> SPOILS / -/ <br /> Storage Method �S 7a t Jam( �Gc� + MATERIALS/DEVELOPMENT <br /> Contamination No n ) A <br /> Storage Location E ct cpm a 4"ez Casing type 1 <br /> op Blank ft. Screen ft. <br /> Slot size 0 " <br /> GROUTING Bags cement / <br /> /. Buckets bentonite Z 3 G <br /> Depth to water Bags sand/gravel 2,57b "' <br /> Mix Ratios 250sax -F' / Filter Pack type/size � <br /> Installation Method a Surge Block: - © n ) <br /> Quantity Installed 71 Discussed with geologist: - On ) <br /> Type of method (1+ G 2t 49 !1 <br /> EH 29 29 <br />