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SONITORING WELL INSTALLATION REPO <br /> Date: f/L9 CONSTRUCTIONS <br /> Premise Address: S 7 S l SCK Total Depth q <br /> Screen Length (from) (to) I <br /> Well No.: W r to ( Filter Pack (from)�(to) <br /> / Bentonite (from) 13 (to) <br /> Inspector: IJ k ,O Grout (from), I t (to) `l� <br /> Drilling rig type V <br /> Permit No. Auger O.D. G2 I.D. <br /> N1 I � � Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: nn <br /> Driller: 1d (�W Yln casing <br /> � � <br /> Consultant /•rl�t5 T height <br /> Geologist <br /> ABOVE-GROUND ' CHRSTY-BOX <br /> CONFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Su tate <br /> Distance to sewer line tx� grout <br /> Domestic well on site - (y A9 Sys{Y II <br /> ft. <br /> If yes, location and distance - <br /> r = m <br /> _ <br /> e <br /> / - C <br /> SAMPLING ZS cA•r slottad _ 8 <br /> /,• salon <br /> Holding Temperature T �/ <br /> Method eztw fi a+4 3fl ��'V _ <br /> Screening Method Z-D S� ; <br /> Tracking Sheet - / n ) <br /> SPOILS Ca,,r <br /> Storage Method � ' MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location e',-iy-� Casing type G <br /> Blanh�ft. Screen <br /> Slot size 0• / <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 6 OF zLg4 /.2C- r — Z a� <br /> Mix Ratios Filter Pack type/size t <br /> Installation Method Surge Block: - O/ n ) <br /> Quantity Installed Discussed with geologist: - / n ) <br /> Type of method <br /> EH 29 29 <br />