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ONITORING WELL INSTALLATION REP# <br /> Date: CONSTRUCTION <br /> z_ � g d, J� <br /> Premise Address: � Total Depth / 1 <br /> Screen Length (from)_ J (to) '} <br /> Well No.: <br /> Filter Pack (from) (to) Z <br /> Inspector: _ L E%�l,°ars Bentonite (from) '7-1 (to) o <br /> Grout (from)_ �r (to) tri <br /> Drilling rig type <br /> Permit No. Auger O.D. it �/ I.D. Y <br /> Drilling Company: ' --/ �/,l-mac <br /> f Completion - Stove pipe/clu-istie box (circle one) <br /> Driller: �cf� casing <br /> Consultants I height <br /> Geologist <br /> ABOVE-GACUND CNAIS�Y-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. around gulxy <br /> COMPL.RiCN <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> SAMPLING <br /> alot:ad <br /> todcn _ <br /> Holding Temperature <br /> Method C % `d, <br /> Screening Method <br /> Tracking Sheet n ) r = <br /> ft. <br /> SPOILS <br /> Storage Method c. i _ MATERIALS/DEVEI.OPMENT <br /> Contamination Notedop <br /> Storage Location , >r fe, Casing type_ <br /> Blank ft. Screen_ <br /> Slot size <br /> GROUTING Bags cement -41 li, c-�-y <br /> Buckets bentonite <br /> Depth to water AG,42/ t-e <br /> Mix Ratios o-,l� rc z lC' Bags sand/gravel- 3 <br /> /y�r� - <br /> �� Faker—Pack type <br /> Installation Method Sur lock: -�( 1 } <br /> Quantity Installed iscussed with geologist:'-/r n ) <br /> EH 29 29 Type of method <br />