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rvIONITORING STALLATION REPOni <br /> Date: <br /> CONSTRUCTION <br /> �/s� � r <br /> n Total Depth /02 <br /> Premise Address: (t <br /> Screen Length (from) 7 o) �Z <br /> Jiaa I Filter Pack (from) /02- <br /> (from) F-3 (to) <br /> (to) — <br /> Well No.: / Benton <br /> Grout (from) <br /> Inspector: t--/—� [�Z/ t/ Drilling rig type / <br /> -I 5 r7d/o-&k7GW Auger O.D. I.D. — <br /> permit No. '/ Completion - Stove pipe/christie box (circle one) <br /> Drilling Coman <br /> py: '" 4 <br /> c 3 <br /> �4.t � ♦` has 9 <br /> Driller: �/ eig t <br /> Consultant Z T <br /> Geologist C.ir""" ABOVE•GRCUND CHRIST!-80x T <br /> COMPLETION COMPLEnON <br /> Ground Surlacs 4//O <br /> SPECIAL PERMIT INFO. <br /> / grout AM// �r2 <br /> Distance to sewer line �1Z <br /> t[ <br /> Domestic well on site - (y "LLe� 5 3 tt € <br /> If yes, location and distances ((r tt <br /> 90 _ <br /> = m <br /> n <br /> = m <br /> SAMPLING ascton =_ <br /> gmviW pack <br /> Holding Temperature <br /> Method 4&>1k4 <br /> Screening Method — =_ <br /> Tracking Sheet - (Y n ) // /U 2 tt. — ft. 105 <br /> ` /05 <br /> SPOILS <br /> Storage Method /"'a""� <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n Casing type 2 Vc' <br /> Storage Location Blank g.7 p ft Scre <br /> 0en /� h• <br /> Slot size - w <br /> GROUTING Bags cement 3f 6 <br /> Buckets bentonite z t <br /> Depth to water ; �� �� ' Bags sand/gravel <br /> 3 <br /> fir Filter Pack type/size <br /> Mix Ratios Surge Block: -®n ) <br /> Installation Method Discussed with geologist: - y�J n) <br /> Quantity Installed �/ <br /> Type of method <br /> EH 29 29 29 <br />