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1 <br /> ONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: 4-707 r�h2/Gr AJer' Total Depth �r c <br /> Screen Length (from) h; <br /> Well No.: /t lil Filter Pack (from) (to) <br /> Bentonite (from) (to) 45 <br /> Inspector. Grout (from) 4 S (to) E� <br /> Drilling rig type rh�f r <br /> Permit No. C l y 5 Auger O.D. / • I.D. tJ <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: /J7h»)Li�IJ <br /> Driller: casing <br /> Consultant 12��aheight <br /> i� _ —QW <br /> Geologist /2/C"Irvu) e-)t'NA � - T <br /> ABOVE-GACUND CHS* Y-BOX <br /> OOWLETION cOMPt.nw <br /> SPECIAL PERMIT INFO. around SuAxs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ tp �_It. <br /> If yes, location and distance - ft. <br /> n. <br /> ^A m <br /> _ O <br /> O <br /> SAMPLING doe nd <br /> A" sockn <br /> Holding lurPack <br /> LC P <br /> Method <br /> Screening Method — <br /> �e <br /> Tracking Sheet • ( n ) <br /> SPOILS <br /> Storage Method �s� MATERIALS/DEVELOPMENT <br /> Contamination Noted - Q n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �S7 S Bags sand/gravel <br /> Mix Rados _ tt F+SL Filter Pack type/size <br /> Installation Methods l S' Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />