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6stINITORING WELL INSTALLATION REP <br /> Date: CONSTRUCTION <br /> Premise Address:- Total Depth 26 <br /> Screen Length (from) Z V (to) t D <br /> Well No.:�e�► 4 ' Filter Pack (from) (to) <br /> Bentonite (from) (to)'� . <br /> Inspector: Grout (from) (to) <br /> Drilling rig type G y++ v 5-5- <br /> Permit <br /> 5- <br /> Permit No. Auger O.D. 19-" I.D. y `� <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: •S� �h• <br /> Driller: casing <br /> � /� height <br /> - <br /> Consultant � V A.. 1�2s-L.�r�,>�r WT <br /> 71 <br /> 10 <br /> Geologist_ zz <br /> - —7 <br /> ABM42ROtMD CHPJM-8OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. around suriwe <br /> Distance to sewer line l D-� P°Ut <br /> Domestic well on site - /n) ��_ <br /> If yes, location and dis e - ? B' <br /> a = - e <br /> SAMPLING <br /> — <br /> Holding Temperature A11e� _ <br /> Method Ong Pack <br /> Screening Method 4177 <br /> Tracking Sheet <br /> % `K / fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location ,� o- <br /> lLCasing type <br /> Blank j 1> ft. Screen t ft. <br /> Slot size -e2. O Z <br /> e� <br /> GROUTING Bags cement <br /> Buckets bentonite z 3 <br /> Depth to water _ Bags sand/gravel <br /> Mix Ratios -p Filter Pack type/size )r <br /> Installation Method Surge Block: - (y/ <br /> Quantity Installed �Z.9'f a/%( Discussed with geo ogist: -6� n) <br /> Type of method <br /> EH 29 29 <br />