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I 14 <br /> I <br /> NITORiNG;WELL INSTALLATION REPO <br /> Al <br /> Date: CONSTRUCTION <br /> •��.iM <br /> Premise Address: 5 �o Total Depth <br /> - <br /> Screen Length (from) _(to)��_ <br /> Well No.• W`f Filter Pack (from) 5to) <br /> —(to) <br /> as <br /> (fro <br /> Inspector: I ,. . Groutnite (from) (to) <br /> (from) (to)�... <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. �— <br /> Completion - Stove;pbox (circle one) <br /> Drilling Company: 1'hA i <br /> Driller. �� II I VV casing, ,G _ <br /> height <br /> Consultant y <br /> ii <br /> II M� <br /> .iABOVE-GROUND C iiS7YBO- x <br /> MP <br /> f I` CpLETlON ~ ".I, <br /> a COMPLnCN <br /> SPECIAL PERMIT INFO. ih , Q=M Swfws <br /> Distance to sewer line III ii 9feut <br /> Domestic well on site - (y/ tt- <br /> If yes, location and distance - <br /> SAMPLING alot:A.i <br /> y „. <br /> Holding Temperature I3 socicn X <br /> Method — t%�Pa <br /> �: <br /> 1 11 <br /> Screening Method ! <br /> I� <br /> Tracking Sheet EY <br /> n ) <br /> SPOILS <br /> Storage Method _MATERIALS/DI;VEI.OPMENT - <br /> Contamination Noted <br /> Storage Location " Casing a <br /> Blank ft. Screen ft.i <br /> Slot size , D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth-to water_ Bags sand/gravel i <br /> Mix Ratios �' - <br /> Filter Pack type/size ! <br /> Installatlon Method ._, t <br /> _._ QJiMWI�p Surge Block: {y/ 1 <br /> Quantity Installed f Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29,17[) 4 <br /> i F <br /> li r <br /> i�. <br />