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)NITORING WELL INSTALLATION REPG. <br /> Date: �/ r CONSTRUCTION <br /> Premise Address: �hT ZV• %����lYl Total Depth <br /> f Screen Length (from) i5 ' (to) qd <br /> Well No. : Filter Pack 131 <br /> Bentonite (from) /,O` " (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type !o- .. f- y <br /> Permit No. Auger O.D. S leb* <br /> Completion - Stove pipe/ u-isd (circle one) <br /> Drilling Company: <br /> Driller: ✓ / J IL aright <br /> he + ht <br /> Consultant ��//411Z//1�<dJ <br /> Geologist ' '/ Kv , aic? T✓% ✓ / 751 <br /> A80VE1iRC(UJND <br /> COMPLETION CNAISTY BCX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground surtxw <br /> Distance to server line grout <br /> Domestic well on site - ( y / b 6 it, <br /> If yes, location and distance - ft- <br /> Iti R. <br /> r� . <br /> SAMPLING dottaiq11 <br /> &aclen <br /> Holding Temperature07 <br /> Method 34) az "iia _ �ravalpadt <br /> Screening Method_ P <br /> Tracking Sheet - ( y / n ) f <br /> a qPN. <br /> SPOILS <br /> Storage Method S jl e 11Nn MATERIALS/DEVELOPMENT <br /> Contamination Noted • ( / <br /> Storage Location Casing type rl C <br /> Blank LS ft. Screen ms's ' ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water > l Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Tit° e� Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />