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ONITORING WELL INSTALLATION REP <br /> 4 <br /> ji <br /> t 5 rs � <br /> Date: CONSTRUCTION <br /> Premise Address: uL TotallDepth Z'D <br /> Screen Length (from) (to) <br /> Well No.: Filter;Pack '` (from) 2d (to) cif _ <br /> Bentonite lL (from)—___3� {to) z <br /> Inspector. Grout' M (from) 2 {to) o <br /> Drilli <br /> 3 d ng rig type <br /> Permit No. Auger,O.D.3 <br /> Completion =;k, Stove pip stie box ' cle one) <br /> Drilling Company:_ 47V4.7Z- AGf <br /> /' �C.�� �f'L.6 i} q I <br /> Driller: [.9- hast casing <br /> ii <br /> i he_ght <br /> Consultant �LO:UQgJ I: <br /> Geologist �C- D✓ i <br /> ABOVE-GACIiND <br /> COt,0LEDdN CfWISTY-BOX <br /> C MPLffnCN <br /> PECIAL PERMIT INFO. C;=nd Swfaca <br /> is ` press <br /> D tance to sewer Iine li d <br /> Domestic well on site - (y/ n ) IE �'Z ft, <br /> Ifes location and distance - <br /> y rr h <br /> ilii ik ^4 m <br /> u <br /> SAMPLING sior.9.i c <br /> Holding Temperature v" <br /> Method I �-' — V, 1Wpack <br /> Screeni P — <br /> ng Method <br /> Tracking Sheet — <br /> fr. <br /> SPOILS ji <br /> ,l <br /> .I ,� • <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ kk <br /> Storage Location 34 Casing type_;'P 20 -2u P V'C i <br /> S�Daptu is ff <br /> Blankli �_ ft. Screen l h. <br /> Slot size i� r 0Z`D <br /> GROUTING Bags cement:[ <br /> Bucket`s bentonite 3144 5 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge I31ock:'.`- (y/ 1 <br /> Quantity Installed Discussed with geologist: -'F% n ) <br /> Type of metliod <br /> EH 29 29 <br /> lk <br /> MC6� au ,fie wt Ch 1Wvr -� <br /> �l�1¢l� <br />