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r&MTORING WELL INSTALLATION REPOt rw <br /> Date:_ Z ' �� 3 1 Tt_1 Gs) CONSTRUCTION <br /> Premise Address: ��L7 �'Gl�X�07 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 5^ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ALS Grout (from) (to) <br /> Drilling rig type <br /> Permit No.— 3 Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: f casing <br /> height <br /> Consultant �/l�N'� /'/ ,[ <br /> Geologist !�f XN <br /> ABOVEGROUND CNA1S'i1,-80X <br /> OOWPLETION OMP <br /> SPECIAL PERMIT INFO. Grourd Surtacro <br /> Distance to sewer line '50 grout <br /> Domestic well on site - (y <br /> If yes, location and distance - <br /> tab fl. ft. <br /> d <br /> = m <br /> = m <br /> — c <br /> — o <br /> PRE <br /> SAMPLING slotted _ <br /> sac1crt <br /> Holding Temperature /NovQ = 7ZY'W Pack <br /> Method =_ <br /> Screening Method — — <br /> �r = <br /> Tracking Sheet - n ) Z-4 2-71-0 <br /> SPOILS e y Cj <br /> Storage Method 43� f S/ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n V <br /> 1 n n✓C <br /> Storage Location -5Casing type J <br /> Blank ft. screen--16.—ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water r Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ) <br /> Quantity Installed Discussed with g ologist: - ) <br /> Type of method F=UP 40t4c'-e <br /> EH 29 29 <br />