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IRONITORING WELL INSTALLATION REPO <br /> Date: O `� V ( CONSTRUCTION <br /> Premise Address: IZV, . Total Depth v <br /> Well No.: �1 y G p Screen Length (from) 47/ (to) ZG. <br /> Filter Pack (from) (to) Z0 <br /> Bentonite (from) (to) <br /> Inspector: Grout <br /> (from) (to) (-- _ _ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> � � Completion <br /> rove pip christie box (circle one) <br /> Drilling Company: <br /> Driller: 9 <br /> n (' casing <br /> Consultant \ WA � � � height <br /> L 4ist c �. w <br /> ABOVE-GROUND <br /> COMPLETION CHRZ`7Y-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surface <br /> Distance to s er line grout <br /> Domestic well on 'te - (y/n ) <br /> If yes, location and ce - <br /> Lin. <br /> 0 . <br /> — o <br /> SLI %Labttsd — c <br /> sec5on - . <br /> 7Hng Tempera e — <br /> Method gravel pads <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( TALA <br /> Storage Location --� Casing TS�e � <br /> Blank Iov ft. Screen <br /> Slot size <br /> GROUTING # Bags cement <br /> Buckets entonite_ <br /> Depth to water Bags(sangravel Q <br /> Mix Ratios Filter type/sized— <br /> Installation Method Surge Block: - (y/(q <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />