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'%,JNITORING WELL INSTALLATION REPO.✓ <br /> Dater CONSTRUCTION <br /> Premise Address: �offf.9✓�/�i Total Depth 4e <br /> Screen Length (from) 0�2 (to) <br /> Well No.: Filter Pack (from) HTO (to) AT- <br /> Bentonite (from) ZZ (to) <br /> Inspector.. dS Grout (from) 3—" <br /> (to)Ser. �cL <br /> Drilling rig <br /> Permit No. 7�— /9Df A ger O.D. type C I.D. � `5� <br /> Completion - Stove pig . Me x cle one) <br /> Drilling Company: i� � <br /> Driller. CSS '2&fene casing <br /> 4� <br /> Consultant � height <br /> � -G " �L� T <br /> Geologist //`����Y _ T <br /> ABCVE-GACUND <br /> COMPLECT4N OHstm-acx <br /> SPECIAL PERMIT INFO. Ground gufwe COMPLEETICN <br /> Distance to sewer line Ori <br /> Domestic well on site - (y/ n ) IL <br /> If yes, location and distance - K. <br /> N <br /> { 0 <br /> SAMPLING — g <br /> �brai � c <br /> saricn <br /> Holding Tempera e <br /> Method�TQ _ pz q pads <br /> Screening Method... �„ _ - <br /> Tracking Sheet - n ) <br /> tL <br /> SPOILS <br /> i <br /> Storage Method On o�lZ MATERIALSMEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location Casing type�o PUCPUC <br /> Blank—& fL Screen 2cA fL <br /> Slot size D <br /> GROUT[NG Bags cement����c <br /> ,t Buckets bentonite <br /> Depth to water Bags sand/gravel3 <br /> Mix Ratios Filter Pack type/siz _ <br /> Installation Method T�uTd Surge Block: - (y i� <br /> Quantity Installed Discussed with geologist:n ) <br /> Type of method <br /> EH 29 29 <br />