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NITORING WELL INSTALLATION REPOt,,,,� <br /> Date; <br /> T A?. CONSTRUCTION <br /> Premise Address:-/r(� �h Total Depth <br /> Screen Length (from)_/�/�(to) .20 <br /> Well No.: �^� Filter Pack (from) i!`1_(to) /X <br /> Bentonite (from) /57 (to) <br /> Inspector. Grout (from) <br /> p <br /> - Auger <br /> rig type Cmc <br /> Permit No._ / Auger O.D. �� I.D. <br /> Drilling Coman .P )r11�� Completion - Stove pipe/ s e ox (circle one) <br />' .4a _ <br /> Driller: C4 'r S / casing <br /> Consultant GCs' <br /> F� 171— <br /> ABCVE-GRCfJND <br /> heightGeologist r G - �'4 T'CHAISTY BOX ' <br /> COA�LE710N O <br /> SPECIAL PERMIT INFO. pnwnd Swf <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - <br /> lc� ft. tL <br /> in 0 <br /> o <br /> O <br /> SAMPLING <br /> s <br /> doral = S <br /> ce✓ sscicn .T _ <br /> Holding Te peva a A: _ � P <br /> ack <br /> Method cf op <br /> Screening Method <br /> .. <br /> Tracking Sheet - / n ) <br /> tL <br /> SPOILS <br /> Storage Method P12 Jr MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y AD <br /> yD �J� <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size . ozc7 <br /> GROUTING . Bags cement !!wa wr�✓i <br /> Buckets bentonite <br /> Depth to water_ `� Bags sand/gravel 3 vnF� <br /> Mix Ratios ` evi Filter Pack type/size <br /> Installation Method Surge Block: - (y� <br /> Quantity Installed Discussed with geologisr.F( D n ) <br /> Type of method <br /> EH 29 29 <br />