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Cl.-NITORING WELL INSTALLATION REPOI, <br /> I <br /> a <br /> C� <br /> # Date: CONSTRUCTION i <br /> r I, <br /> Premise Address: w Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 5Z (to) <br /> + Bentonite - (from) ' a— (to) <br /> Inspector: Grout (from) 3511— (to) <br /> Drillingrig ppe <br /> Permit No. Auger . D. <br /> CompletionStove pip iristie box ' cle one) <br /> Drilling Company: ;? <br /> l <br /> Driller: casing <br /> he, <br /> Consultant_ Yy P�— <br /> i Geologist � »• T <br /> ABOVE4A UND <br /> =O PL UE bN CiiRiSTY-SaX <br /> COMPL.EnON <br /> SPECIAL PERMIT INFO. # Ground Surface <br /> Distance to sewer linegrout r <br /> i <br /> Domestic well on site - (y n <br /> If yes, location and is an ����, tt- <br /> =it.,F <br /> SAMPLING j sbrad <br /> � satscn �: <br /> k. Holding Temperature <br /> a <br /> Method ' _ <br /> Screening Method 41 f:D <br /> F k. <br /> Tracking Sheet - {y/ n ) <br /> fie <br /> SPOILS <br /> Storage Method 6711 U'`�t''� � MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location Casing type <br /> Blank ft. Screen, .mac ft. <br /> Slot size r6 . . ?- <br /> GROLMNG / Ba 'cement 1 i io <br /> r , f Buckets bentonite I <br /> Depth to water `t� M _ Bags'sand/gravel <br /> Mix Ratios Filter Pack type /size_ <br /> Installation Method Surge Block: - { y/ii ) <br /> I <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Typejof method <br /> EH 29 29 n 31 <br /> f <br />