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40NITORING WELL?INSTALLATION REP- <br /> Date: O CONSTRUCTION <br /> Premise Address: 00, <br /> E Total Depth 90 <br /> Well No.: i�fiL!/' Screen Length (from) O (to) <br /> Filter Pack (from)_ 90 (to) 7 <br /> Inspector: �7Lt.�+it� Bentonite (from) 7J' (to) 7/ <br /> Grout (from) ( (to) t 7- <br /> /6r�Z Z Drilling rig type <br /> Permit No. 7r Auger O.D. $ I.D. <br /> Vic, <br /> Completion - e/christie box (circle one) <br /> Drilling Company: <br /> / <br /> Driller:_ / '� 7` t )height <br /> Consultant i.�dt-1l <br /> Geologist_ L <br /> D <br /> VIE —WW-f <br /> COMPLETION CHR*TY-BOX <br /> SPECIAL PERMIT INFO. GroundStufwe COMPLETION <br /> Distance to sewer line 1;4 proof <br /> Domestic well on site - n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> y <br /> SAMPLING dotted I <br /> = c <br /> G vaysi pack <br /> secyan <br /> Holding Temper�aturX _ = <br /> Method (�C = <br /> Screening Method NO^� <br /> Tracking Sheet -G3n ) qq,,LJk <br /> ft. <br /> SPOILS <br /> Storage Method Q1rQ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location.. 0-j- Casing type Zr �a�i '1O Ptl <br /> Blank 75 Mfr. Screen ft. <br /> Slot size .070 <br /> GROUTING Bags cement 1 <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel (o <br /> Mix Ratios 6pce Filter Pack type/size 3 <br /> Installation MeThod Surge Block: -Q'n ) <br /> Quantity Installed Discussed with geologist: -(Dn <br /> Type of method_ &s.(/CL�� <br /> EH 29 29 <br />