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ONITORING WELL INSTALLATION REP <br /> Date: '3 - 9 - 12-��,"I CONSTRUCTION <br /> Premise Address: C'j 1 Fat l C A4'� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: ! .2 Filter Pack (from) _(to) 2'2 <br /> Bentonite (from) ?2 (to) <br /> Inspector. cj `�CL�"7(sYt Grout (from) % °r3 (to) B <br /> Drilling rig type <br /> Permit No. Auger O.D. C 25' I'D. <br /> Completion - Stove pip ox ircle one) <br /> Drilling Company: '=�1 • e b <br /> Driller: casing <br /> he_ght <br /> Consultant <br /> Geologistf-� �� AgpyEGACUND <br /> CONFLUION CS•tOX <br /> PLEEM <br /> CCMPLE7ICN <br /> SPECIAL PERMIT INFO. Ground Surtax + � <br /> PS : <br /> Distance to sewer line grout <br /> o <br /> Domestic well on site - (y/ n) tt, <br /> if yes, location and distance - ft. <br /> tt. <br /> Y <br /> = o <br /> SAMPLING dorsi <br /> •onion <br /> Holding Temperature 'n, P <br /> Method <br /> Screening Method <br /> Tracking Sheet - (/ <br /> n ) +, _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted-- QD <br /> O <br /> Storage Location N S I Casing type x ------------- <br /> -- <br /> Blank -Z¢ fr. Sc een -Z.S ft. <br /> Slot size J-G <br /> GROUTING Bags cement <br /> Buckets bentonite �f�3 <br /> Depth to water �; Bags sand/gravel <br /> Mix Ratios K Filter Pack type/size G �Z <br /> Installation Method l-A—A— Surge Block: - ( y AD <br /> ) <br /> Quantity Installed Discussed with geologist: - (y/ n(� <br /> Type of method_ NT <br /> EH 29 29 <br />