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'-VONITORING WELL INSTALLATION REPOI;a� <br /> Date: ��� \� CONSTRUCTION <br /> Premise Address: Total Depth�?7 <br /> Screen Length (from) t��z—� (to) _ <br /> Well No.: Filter Pack (from) 415 (to) 140 <br /> Bentonite (from) 40 (to) N' <br /> Inspector. 1 meq, Grout (from) 3t_ , (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 3 <br /> Completion - Stove p' e/ retie boy (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> L <br /> height <br /> Consultant ���`�UNAI� <br /> Geologist a A A, Fl� •- <br /> ABOVE-GRCUND CttRtM43OX <br /> COWLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surtaca <br /> Distance to sewer line proof 1253r "I <br /> �, rP� <br /> Domestic well on site - (y/ n) 1013476 <br /> If yes, location and distance - / <br /> Jlh — 406('em <br /> V• M <br /> SAMPLING alore.� — <br /> . an <br /> `fit r <br /> Holding Temperature <br /> Method — <br /> Screening Method \ <br /> Tracking Sheet y/ n ) -' _= <br /> a ' <br /> SPOILS <br /> Storage Method IVI MATERIALS/DEVELOPMENT <br /> Contamination Note - y n ) <br /> Storage Location �W/' Casing type VC <br /> Blank ft. Screen 40 ft. <br /> Slot size b •y.1u�� <br /> GROUTING Bags cement <br /> Buckc ntonite <br /> Depth to water Ba n gravel <br /> Mix Ratios -1" Filter ack type/size r1 - O <br /> Installation Method T�IWIUA Surge Block: - (y/Ui ) <br /> Quantity Installed Discussed with 901 ist: - {�} / n ) <br /> Type of method <br /> EH 29 29 <br />