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c <br /> UNITORING WELL INSTALLATION REPO <br /> Q <br /> Date: C>a I Cl I CONSTRUCTION j <br /> 2� fv t t ti 111th (�t P1 J Total Depth <br /> Premise Address: iib <br /> Screen Length (from) (to) <br /> Well No.: - YIW 1715 — to Filter Pack (from) O.'s (to) (25 <br /> Bentonite (from) fa X (to) !o(o <br /> Inspector: S• SC1At1t31Dti^(L' Grout (from) to(e (to) i3 <br /> Drilling rig type Cjr LS "1`` <br /> Permit No <br /> Auger O.D. S 6.2 <br /> ,1 Completion_ Stove P ats <br /> tie bo (circle one) <br /> Drilling Company. n`^ <br /> Driller: casing <br /> height <br /> Consultant�,� j rV <br /> 7EW-F <br /> Geologist A80VEd9RCUND <br /> COh1PLFTCN COOMPLCMPLY-BOX <br /> ETION <br /> SPECIAL PERMIT INFO. Ground S�a� <br /> Distance to sewer line grout <br /> Domestic well on site - ( n) ft. <br /> If yes, location and distance - tL <br /> DV44)(Vpu� UAL, <br /> o <br /> SAMPLING slorad <br /> aeclen <br /> i Holding Temperature C - _ grava�past <br /> 1 Method ° M- 1C.r <br /> Screening Method <br /> Tracking Sheet - n ) qb <br /> ft. <br /> SPOILS - <br /> Storage Method W1 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> 1 Storage Location pts SrnL Casing type -�2't GCA- 41�) PVC— <br /> Blank ft. Screen <br /> Slot size 0. 02c--5 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size l tTU�`r1 (1 <br /> Installation Method Surge Block: - (gy n ) <br /> Quantity Installed Discussed with geologist: - j n) <br /> Type of methodZak ,nv' r tn9� <br /> EH 29 29' <br /> i <br />