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�.. MONITORING WELL INSTALLATION REAwwtT <br /> Date: _��/ CONSTRUCTION <br /> Premise Address: ��7�(,Q IN_T, Total Depth <br /> / Screen Length (from) _L5- (to) S <br /> Well No.: Filter Pack (from) Z(7;- (to)� <br /> Bentonite (from) (to) 2- <br /> Inspector: <br /> Inspector: Grout (from) (to) 1 <br /> Drilling rig type <br /> Permit No. 0'D to 6-1 Auger O.D. q I.D.tbox' <br /> i <br /> Completion - Stave pip 'e (circle one) <br /> Drilling Company: �kwzw <br /> Driller: lav YU casing <br /> IT7 T height <br /> Consultant uV71 —EW7F <br /> Geologist <br /> ABOVE-GROUND CtiR ST'Y-80X <br /> COMPLETION COMPt_EnCN <br /> SPECIAL PERMIT INFO. Ground Surfact + �--� <br /> Distance to sewerline ��� grout <br /> Domestic well on site�/ ri ft. <br /> If yes, location and cisfance - <br /> = e <br /> = e <br /> — c <br /> — o <br /> SAMPLING aloud = c <br /> section <br /> Holding Tempera e , = 41vd Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - / n ) <br /> % = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) <br /> Storage Location Casing type ')6A � � <br /> Blank (A ff ft. Screen :?.c ft- <br /> Slot size O o l c) <br /> GROUTING Bags cement 2 / }v-P <br /> Buckets bentonite <br /> Depth to water Bagftai� <br /> an gravel gravel <br /> Mix Ratios __ Filt ize / <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: -(0/ n ) <br /> Type of method LJ'if'� 0- <br /> EH 29 29 <br />