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MONITORING WELL INSTALLATION REPO <br /> Date: �I Io CONSTRUCTION <br /> Premise Address: 7oa Total Depth lob <br /> Well No.: <br /> /kyr `3 Screen Length (from) (ro) 2 <br /> Filter Pack <br /> (from) /OD (to) U <br /> Inspector: Bentonite (from)�(to) <br /> Grout (from) (to) -iL <br /> Permit No. <br /> D �6�5 Drilling rig type <br /> Auger O.D. JZ I.D. <br /> Drilling Company: �� Completion - Stove pipe/christie box (circle one) <br /> Driller: 'A4, ry casing <br /> 3 height <br /> Consultant lC'.f' �{.f'LiG1 <br /> Geologist / L <br /> A80 WE ROU <br /> CONPI N CNAISN-BOX <br /> SPECIAL PERMIT INFO. GroundBoxy COMPLETION <br /> Distance to sewer line /✓ 0r� <br /> Domestic well on site _ ( Y/( y/ ) <br /> If yes, location and distance - ft. <br /> n. <br /> = m <br /> — o <br /> = m <br /> SAMPLING <br /> slotted & <br /> 9 soctcn = <br /> Holding Temperature = _ <br /> Method = V'VW Pack <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) <br /> SPOILS �" <br /> Storage Method_ -at /ut.�( /[x C^ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (yam` <br /> Storage Location v Casing type <br /> Blank 8. Screen ft. <br /> Slot size a ft <br /> GROUTING Bags cement 22 /fit ll p. <br /> Buckets bentoniteo <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 22 (7$ Filter Pack type/size /y <br /> Installation MethoSurge Block: - y n <br /> Quantity Installed 0 Discussed with geol 'st: - (yn <br /> EH 29 29 <br /> Type of method �d«. <br /> o! /.m <br />