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'NWJNITORING WELL INSTALLATION REPOy <br /> Date: /U CONSTRUCTION <br /> Premise Address: a J Lel Total Depth Y- .3U --�5 <br /> n � Screen Length (from) (to) <br /> Well No.: J� Filter Pack (from) (to) <br /> Bentonite (from)— (to) 6 <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 9 �67�-- Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company- <br /> Driller: 5 �x casing <br /> height <br /> Consultant <br /> Geologist w/�ja)Y7 An�i� <br /> ABCVE-GRCUNO CHMM-aCX <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. n Ground Surfact <br /> eT <br /> Distance to sewer line '%y -'1ti`{� grout <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and dist ce M <br /> - ft. <br /> SAMPLING alor:ed = c <br /> 0 nl� aodcn -" <br /> Holding TemperaturePack <br /> ".. <br /> Method <br /> :<>.. — <br /> Screening Method Q ^ <br /> m• _ <br /> Tracking Sheet - (y/ n ) -J <br /> SPOILS <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> Contamination Noted - n <br /> Storage Location 0Y Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROU'T'ING Bags cement <br /> 3.�/ Buckets bentonite <br /> Depth to water l�!�� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 n <br />