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MONITORING WELL INSTALLATION REPC,4 <br /> CONSTRUCTION <br /> Premise Address: 13 L/9 5 le 6&44kz(6 Total Depth__ _ <br /> Well No.: Al •W Screen Length (from) /n d (to) 3 <br /> Filter Pack (from), l -(to)-ZO <br /> Bentonite (from)_�o (to) <br /> Inspector: u Grout (from)-2,8.. (to) w <br /> Drilling rig type <br /> PermitNo. Auger O.D.-40 <br /> c <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> J Wc-G „ „ .. <br /> -w..` <br /> Driller: � casing \) <br /> height <br /> Consultant Z � �7-_-Z__ <br /> Geologist At/ E�1 �, .` T <br /> ASOVE-GROUND <br /> COMPLETION CHRISTY-BOX <br /> COMPLETIO <br /> SPECIAL PERMIT INFO. <br /> around Surd <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - {y ft. <br /> If yes, location and distance - D �, <br /> tt, <br /> 0 <br /> — m <br /> c <br /> _ o <br /> SAMPLING slot — $ <br /> section — <br /> Holding Temperature c� grsval pack <br /> Method <br /> Screening Method_0 L/9 <br /> Tracking Sheet - / n ) // ' — <br /> 0 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT, <br /> Contamination Noted -, y n ) - <br /> Storage Location Casing type POC,/ _ <br /> Blank- 35- ft. ,Screen _ft. <br /> Slot size 02,0 ' <br /> GROUTING Bags cement 3 <br /> y Buckets bentoriio S <br /> Depth to water qBags sand/gra/el, <br /> Mix Ratios1y_teC(_r' Filter Pack tyFgeo/l�(ugist: <br /> Installation Method t� Surge Block: n.) <br /> Quantity installed y l- _ Discussed wi / n ) <br /> Type of method <br />