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t,dNITORING WELL INSTALLATION REPO <br /> Date: 11/1�9� CONSTRUCTION <br /> Premise Address:& SX) P� Total Depth Ih <br /> /s / �/ Screen Length (from) D (to) <br /> /(ttl- Mw 2� <br /> Well No.: � a''(' Filter Pack (from) � D (to) �- <br /> �� p Bentonite (from) Zz (to) 'Lo <br /> Inspector: �'� ( Grout (from) z-o (to) <br /> QD 33 Drilling rig type /3` <br /> Permit No. Auger O.D. K /y I.D. z <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant TIV <br /> -� <br /> Geologist ���� fi✓d �^ - T <br /> ABOVE-GRCUND Ct4i75TY BOX <br /> COMPLETION OCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surlata <br /> Distance to sewer line A--//L or1°"t <br /> Domestic well on site - y n) 7 ft. <br /> Ifes, location and Otstance - <br /> y L/L�' ACA-"- b2 M w 2 n ft. <br /> _c o <br /> SAMPLING ` <br /> dorad s: _ <br /> soden = — <br /> Holding Tem erature <br /> Method ACJ- _ praval patlt <br /> Screening Method <br /> Tracking Sheet - / n 7XRE <br /> SPOILS / <br /> Storage Method -SVCP. < tt � o� j MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y I <br /> Storage Location a Casing type Z /,(/C, <br /> Blank 2 ft. Screen-15- <br /> Slot <br /> creen Slot size . bZ o <br /> GROUTING Bags cement 5- <br /> Buckets <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel '*/T <br /> Mix Ratios Filter Pack tWe/ 'ze #T <br /> Installation Method Surge IIlock / n )Quantity Installed E f Discussed wologist: - / n ) <br /> Type of method ���✓✓✓ <br /> EH 29 29 <br />