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_ t <br /> �NITORING WELL INSTALLATION REPO <br /> SN' <br /> Date: �' 7 7 ' ( / CONSTRUCTION <br /> /' <br /> Premise Address: Total Depth <br /> j s Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) 2 <br /> . Bentonite (from).- <br /> Inspector. ��. � �©���� r Grout (from) (to) -� <br /> Drilling rig type !. Qq <br />' Permit No. ��S�,�,�r Auger O.D. �O_ LD-- <br /> IW'� Completion- Stove pipe/ s[ie box irde one) <br /> Drilling Company: <br /> Driller: casin <br /> height <br /> Consultant_ <br /> Geologist AN - r <br /> :. ABOVE-GACUND CFffa1STY-80X <br /> OO&PLETION COMPLEnON <br /> SPECIAL PERMIT INFO. Gourd �i�� <br /> / T <br /> Distance to sewer line 7 3 graA <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - tL <br /> ! ! V r4 C <br /> SAMPLING abra.7 <br /> soctcn = 3 <br /> Holding Temperature •G = 9M N pack <br /> Method Ci /Get' NO Sraw�k.reS ID 4rg) <br /> Screening Method �M <br /> Tracking Sheet - (y/ n) <br /> fL fL <br /> SPOILS <br /> Storage Method />DT (\WMe, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location hsu SiCasing type 2' ca( 4t7 AVC, <br /> Bl; 413 ft. Screen, O ft. <br /> Slot size D._07v <br /> GROUTING Bags cement 7S <br /> / Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation MethodrtiM Surge Block: - f©/ n ) <br /> Quantity Installed 1tr75 Discussed with geologist:��-�(V n) <br /> Type of method <br /> EH 29 29 <br /> ,Ctva1 S 7.D <br />