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N4 � ITORING WELL INSTALLATION REPORT` <br /> rl r6 YL <br /> li Date.. / / CONSTRUCTION <br /> d Premise Address : / �/ l� bN � D��� / Sf Total Depth fid ! <br /> Screen Length (from) (to) 574 <br /> Well No.: Filter Pack (from) 9 (to)s 1 <br /> �/ /jam Bentonite (from) (to)S <br /> Inspector: fC Grout (fro ) (to)Bcc <br /> Drilling rig e S <br /> Permit No. !q 7 ' 3675 Auger O.D. 7/4 " LD. <br /> Consultant <br /> D Completion - Stove pipe/christie box (circle one) <br /> �R� �d� <br /> Geologist A atck•oP <br /> �� o,✓ � �Pov�? C Z- 6f9a <br /> SPECIAL PEI&T INFO. ABOVE•GRCUND <br /> <�MPLEf,AN CHA15T`l-80X <br /> Distance to sewer line �' COMPLETION <br /> Domestic well on site - ( y /(n Ground S 7 � <br /> If yes, location and distance - grout <br /> _1Lft. <br /> SAMPLING <br /> Holding Tem er!r. _ $ <br /> Method soc9on <br /> Screening Method / = grz+ w Pack <br /> Tracking Sheet - y / n ) ; <br /> ft. <br /> SPOILS <br /> Storage Method ' ` ��� d "t � MATERIALS/DEVELOPMENT <br /> Contamination r4otes - ( y /60 <br /> Storage Locat.... Casing type Z Pkv <br /> Blank SS ft. Screen /S ft. <br /> Slot size , ) Z-/ <br /> Bags cement 'L T 9 <br /> GROUTING Buckets bentonite / � f <br /> Bags sand/gravel 71 J /� <br /> Depth to water b? Filter Pack type�/s��' f,a N7 <br /> Mix Ratios usc. � ,. " Surge Block: - U n ) <br /> Installation Method LZvU-4f_ Discussed with geologist: - n ) <br /> Quantity Installed i L ,o 6i. c� /SUr=Z' Type of method <br /> I <br /> 1116 <br /> � Z/ <br />