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1 � <br /> INmONITORING WELL INSTALLATION REPO <br /> Date: lel c12 CONSTRUCTION <br /> f <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: h't l�''1- Filter Pack (from) 15 (to) <br /> 11 ll Bentonite (from) (to) 3 <br /> Inspector: Grout (from)_ 3 ((to) <br /> Drilling rig type i K CO <br /> Permit No. Auger O.D. I.D. t--2 <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � -�(-, ►�2.1,1�� — <br /> 3 � <br /> Driller: casing <br /> C,� � �� height <br /> Consultant <br /> Geologist -- <br /> ABOVE-GRCUNO CNRSSTY-SOX <br /> COMPLETION COMPLE71ON <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> 7 <br /> Distance to sewer line > grout <br /> Domestic well on site - (y �_ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> M <br /> SAMPLING <br /> sacJcn <br /> Holding Temperature AA SL-�-- <br /> Method — RAYW Pack <br /> Screening Method 21 —_ <br /> Tracking Sheet - (y/ n ) <br /> '.R <br /> SPOILS <br /> Storage Method_M a 'w"' r MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n <br /> Storage Location -rL tv'k Casing type Z `,)Clk,VN ft. <br /> Blank g ft. Screen <br /> Slot size D <br /> GROUTING Bags cement 1 <br /> i Buckets bentonite <br /> Depth to water 0 Bags sand/gravel <br /> Mix Ratios wryg i/— Am, -7 aw L_ Filter Pack type/size 211 <br /> Installation MethodfV-y< CIWLX _ Surge Block: - (V n ) <br /> Quantity Installed I Discussed with geologist: - (V/ n ) <br /> Type of method IZL4 r'v6an- ufl <br /> EH 29 29 <br />