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MONITORING WELL INSTALLATION REPO <br /> u <br /> Date: rJ ' c1 5 CONSTRUCTION W} } ' "vi <br /> Premise Address: c-{ Total Depth <br /> Screen Length (from) bio (to) Iic <br /> Well No.: I"1 Filter Pack (from) 30 (to) a <br /> � � " � �–, Bentonite (from) S (to) L <br /> Inspector. Mx Grout (from)—�(to) <br /> Drilling rig type <br /> Permit No. 0O fo a Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ 'M %'4che�2.2 <br /> Driller: R0� S�� V_I <br /> heg4ht <br /> ConsultantWW �RWt n �Geologist �1� L—U KS1 L r <br /> ABOVE-GROUND CtWISiY80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Suixt <br /> Distance to sewer line <br /> y.1 grout <br /> Domestic well on site - (y �_.ft. <br /> If yes, location and distance <br /> ft. _ <br /> - u <br /> SAMPLING <br /> slotted <br /> sedcn <br /> Holding Temperature <br /> Method ILQ _ IravaPadt <br /> Screening Method PtD <br /> Tracking Sheet - n ) l7 o rt� t <br /> SPOILS <br /> i <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination No <br /> Storage Location Casing type <br /> Blank to ft. Screen Za ft. <br /> Slot size 02- <br /> GROUTING <br /> ZGROUTING Bags cement <br /> SJ- Buckets bentonite <br /> Depth to water t�� 2 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ }6 <br /> 1 Quantity Installed Discussed with geologist - (y/6 <br /> Type of method <br /> EH 29 29 <br />