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r ' <br /> �ANITORING WELL INSTALLATION REPG%%d <br /> Date: // " y 7 CONSTRUCTION <br /> Premise Address: llir,�nG Total Depth <br /> / Screen Length (from) 2 (to) <br /> Well No.: ! by — a2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. _ ��1� Grout (from) -elo (tol . <br /> Drilling rig type P_ Y4y <br /> Permit No. Auger O.D. 9�� I.D. <br /> Drilling Company: <br /> Completion- Stove pipe/christie box (circle one) <br /> S�'�""`' <br /> Driller. casing <br /> `! height <br /> Consultant z, / T <br /> Geologist G� T <br /> ABOVE-GROUND <br /> COMPLETION CHRIM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line l B"D WoLd <br /> Domestic well on site - <br /> n) <br /> If yes, location and die e - <br /> Y � <br /> SAMPLING <br /> ascdon <br /> Holding Temperature �7 l-g-',"t e <br /> Method ��P <br /> Screening Method <br /> Tracking Sheet (3V1 n) :' = <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted ,eff/ n ) <br /> Storage Location Casing type 2&dze <br /> Blank 142 ft. Screen j 9 fL <br /> Slot size 12, D R <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel ':�_A� <br /> Mix Ratios Filter Pack type/size 0-02 <br /> Installation Method Surge Block: - (y A:r) <br /> Quantity Installed Discussed with geologist: - n) <br /> Type of method— <br /> Eli 29 29 <br />