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140NITORING WELL INSTALLATION REPO <br /> Date: I " ` l I CONSTRUCTION <br /> Premise Address: � r Total Depth Z Z— <br /> j�/1 Screen Length (from) U �(to)l7—Z2:-Well No.: w Filter Pack (from) (to)Bentonite (from) (to) <br /> Inspector: J.`�g1C Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. 1Cb <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company n( V '�'s`�"� �• <br /> Driller: ' " , CaS.L <br /> J height <br /> Consultant � W� � ,V.Vnr''1' T <br /> t-- � T <br /> ABOVE-GROUND CHRI!M-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surixa <br /> Distance to er line grout <br /> Domestic well o •te - (y/n) 1 9 n <br /> If yes, location and ce - q I, ft <br /> m <br /> _ <br /> _ o <br /> SAMPLING slatted <br /> Holding Tem afore —_ 9svel pack <br /> Method ' <br /> Screening Method <br /> Tracking Sheet - (y/n y. <br /> SPOILS <br /> Storage Method 6 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location VW X11 Casing type Gam' 1 U ��� <br /> Blank �l ft. Screen ZG ft• <br /> Slot size t <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size CA <br /> Installation Method y Surge <br /> Quantity Installed Discussed with geologist: - (y/ n <br /> Type of method <br /> EH 29 29 <br />