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49NITORING WELL INSTALLATION REPO <br /> Date: '4 CONSTRUCTION <br /> Premise Address: 4702 Oq3-(- 5R" Total Depth C <br /> Screen Length (from) (�4 _(to) <br /> Well No.: Filter Pack (from)- S <br /> Bentonite (from) t S (to) �! --�� <br /> Inspector. i <SCY h�( l ilii Grout (from) (to) C3 <br /> Drilling rig type <br /> Permit No., Auger O.D. lc z S I.D. Y-z� <br /> �q Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company. I�JZY1t�t�r7zi� /y GQLIftI <br /> Driller: &Zi ' casing <br /> �T he_ght <br /> Consultant IZvS,ti'✓k <br /> Geologist T <br /> ABCVE•GRCUND CHR*TY•3OX <br /> COMPLETION CCMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line RR <br /> grout <br /> Domestic well on site - (y/0 �_ft. <br /> If yes, location and distance - n- <br /> n. <br /> _ o <br /> SAMPLING clots = c <br /> cocicn <br /> Holding Temperature `H' yTayslPadt <br /> Method <br /> Screening Method <br /> Tracking Sheet - (yV n ) <br /> SPOILS <br /> Storage Method 0 i N MATERIALS/DEVELOPMENT <br /> Contamination Noted • / n ) <br /> Storage Location ' n l G,'iZ.' Casing type 2 ' 5Cb1 k' P\((— <br /> Blank <br /> J(- <br /> Blank <fy ft. Screen S ft. <br /> Slot size 67, Dw <br /> TI <br /> GROUNG Bags cement ��° <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size /Z <br /> Installation Method Surge Block: - n ) <br /> Quantity Installed la K Discussed with geologist: - 61 n ) <br /> Type of method__;77/ <br /> EH 29 29 <br />