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ii .;`i ce ii �i i i _ -i"`� <br /> i4 n �1 <br /> j �. ONITO`RING WELL INSTALLATION REPIU, <br /> Date•,,. �' 1 CONSTRUCTION .: <br /> Premise Address: 2�' �.. Total Depth <br /> '� <br /> IN 41. + 2= Screen Length from to (o b <br /> 1 <br /> Well No.: W_CJ i' Filter Pack {from) i$5 (to) <br /> Bentonite (from) C2. (to= <br /> Inspector: M U&tAO Grout (from) � ' (to) <br /> I i' '�, . .Drilling rig type ': {Yl a t I .(p <br /> Permit No. Auger O.D. O I.D. <br /> Completion - Stove pipe/christie box (c' cle one) ; <br /> Drilling Company: U I �YAU <br /> Driller. R60 cfasLnq� Y <br /> heLght <br /> Consultant <br /> Geologist_ ` <br /> ABOVE-GROUNDI w.�. CHR�SW4= <br /> CCMPLET$CN COMPLEIICN <br /> SPECIAL PERMIT INFO, &wnd S ewe <br /> Distance to sewer line <br /> Domestic well on site - (y ft. <br /> If yes, location and distance - ... .. <br /> SAMPLING ii. ,i; - . ., siotled — ,4 <br /> sadcn <br /> Holding Temperature 1Pack <br /> 3 „. _ <br /> Method <br /> Screening Method P(J2 <br /> Tracking Sheet - 6' n ) <br /> : w <br /> f ' <br /> SPOILS9 <br /> Storage Method MATERIA1.5MEVI~I,.,OPMENT <br /> Contamination Noted - (y n <br /> Storage Location , Casing type 2:ryC. <br /> Blank_- kp ft. Screen 2 r2ft. <br /> Slot size - 0Z t) <br /> GROUTING <br /> Bags cement <br /> Buckets bentonite .: <br /> Depth to water a Bags sand/gravel —75 <br /> Mix Ratios Filter Pack type/size <br /> Installation Method a! ' ! Surge Block: ( y ) <br /> Quantity Installed { Discussed with geom.logist: (� n ) <br /> :! Type of method <br /> EH 29 29 4j <br /> ii Ii •�i s►N <br /> di. 't <br />