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_JNITORING WELL INSTALLATION REPO- <br /> Date:— <br /> EPO_Date:2/ [ CONSTRUCTION <br /> Premise Address: �U� Total Depth <br /> n I� Screen Length (from) SSS (to) 76 <br /> Well No.: 1/ I Filter Pack (from) �f (to) <br /> Bentonite (from)--L'-) (to) Yi <br /> Inspector. Ss Grout (from) (to) </b <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> Completion - Stove pipe cluistie x (circle one) <br /> Drilling Company: <br /> Driller: � V <br /> casing <br /> /� f� s- he_ght <br /> Consultant ��D l(f�Ut/K� – <br /> Geologist FatL -t i I180VEraACUND <br /> OOWLETION CCMPLZnCN <br /> CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sut'cs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y ft. <br /> If yes, location and distance - ft. <br /> n. <br /> = e <br /> = c <br /> — o <br /> SAMPLING abrad _ -E <br /> wc9on —_ <br /> Holding Temperature 7 = pavq pack <br /> Method / P C� Cti� /✓ /ro ( o� "' <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> n. = M <br /> SPOILS <br /> Storage Method � MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) <br /> Storage Location f32') Vic _ Casing type <br /> Blank---'Z; ft. Screen Z C— ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel iZ <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 />