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.- <br /> INVONITORING WELL INSTALLATION REPOi,,f <br /> Date: CONSTRUCTION 8 r , s <br /> Premise Address: q3C4-:-;7" Total Depth 's <br /> Screen Length (from) .S (to)-yam <br /> Well No.:- L4W. Filter Pack (from) - . o!y S� <br /> -(to) � <br /> � �/{ Bentonite (from) "7;-•5 (to) 7065 <br /> Inspector. �T` <br /> P , Grout (from)_ 70• _(to) a <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Drilling Company: <br /> Completion - Stove pipe/ tristie boy ircle one) <br /> - C'.{.piG��i <br /> Driller. casing <br /> height <br /> Consultant <br /> Geologist '1 _ �► <br /> ABOVE-GROUND Cr4FtcSTY-90X <br /> COA�LETfON COMPI.ET1CN <br /> SPECIAL PERMIT INFO. around Surface <br /> Distance to server line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> r <br /> SAMPLING o <br /> alorai <br /> socicn � <br /> Holding Temperature <br /> Method = gravel pacts <br /> • — <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> �..__ft. ir — tt. <br /> SPOILS <br /> Storage Method JS P f ( � MATERIALS/DEVELOPMENT <br /> Contamination Noted -W n ) '- <br /> Storage Location Casing type Y11C SCA E <br /> BIank. "7q ft. Screen -77D ft. <br /> SIot size 0,0.�-- <br /> GROUPING t Bags cement q 5etk- vte6 C4� eco„ S! <br /> 76` Buckets bentonite J r <br /> Depth to water Bags sand/gravel ZIR� <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 />