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.JNITORING WELL INSTALLATION REPO. . . <br /> I <br /> I Date: l 7 CONSTRUCTION <br /> Premise Address: Total Depth <br /> r Screen Length (from) (to) <br /> Well No. : /ZV J Filter Pack (from) (to) 0 <br /> C (� Bentonite (from) /D-S (to) /3 <br /> Inspector:Sr �Sd�� Grout (from) O (to) /D -S <br /> Drilling rig type u � <br /> Permit No. Auger O.D. .F� I. <br /> // AII ee Completion - Stove pipe/ tstie b (circle one) <br /> Drilling Company: <br /> CZ! X <br /> Driller: /�//y1 /1 casing <br /> he _ght <br /> Consultant7541 <br /> Geologist ��� ��� � •- <br /> ABOVEdaRCUND Ct6i1S1Y BCX <br /> COWLETICN CCMPLETICN <br /> SPECIAL PERMIT INFO. G=rd Sudan <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) ft, <br /> If yes, location and distance - <br /> Re <br /> — a <br /> SAMPLING = c <br /> — o <br /> alotted c <br /> saricn S <br /> Holding Tempera 9 Oe . �/J els = gravel Pads <br /> Method i1 61 //e <br /> Screening Method r = <br /> Tracking Sheet • ( y / n ) _ <br /> ti. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location_ Casing type <br /> Blank /�' ft. Screen o' 'S" ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 26 ,1 <br /> 6 , Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: • ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />