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GNITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: /,707 h; '��1 C ��y Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: J 1 y 4 Filter Pack (from) (to) 2 <br /> Bentonite (from) ZZ (to) 2C� <br /> Inspector: �� `�L �/ n� Grout (from) 2-0 (to) C <br /> Drilling rig type <br /> Permit No. q; -6403 Auger O.D. I.D. <br /> Completion - Stove p cluis[ie ox (circle one) <br /> Drilling Company: ���2 / <br /> Driller: 7Dh+ l �CaTi � I casing <br /> height <br /> ConsultantL -EWT <br /> 2i Snf.4 <br /> Geologist ai -"�qr2� - <br /> ABOVE-GROUND GiMM-BOX <br /> COMP1.EMN CCMPL-=nCN <br /> SPECIAL PERMIT INFO. Gro+rd Uref <br /> Distance to sewer line N� grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> ft. <br /> •q' <br /> V' 0 <br /> a <br /> 0 <br /> SAMPLING <br /> axicn — <br /> Holding Temperature l("tom <br /> Method <br /> Screening Method <br /> Tracking Sheet • ( y/ n ) '.T <br /> ft. __ = IL <br /> SPOILS <br /> Storage Method % MATERIALS/DEVELOPMENT <br /> Contamination Noted . y n ) 11 <br /> Storage Location IIA-/ 5i /-ZT— Casing type A <br /> Blank 1�ft. Screen_____: ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 4 q Bags sand/gravel <br /> Mix Ratios ftp Filter Pack type/size <br /> Installation Method Surge Block: - (y,Cu-' <br /> Quantity Installed Discussed with geologist: - ( y/(�ff)) <br /> Type of method <br /> EH 29 29 <br />