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WNITORING WELL INSTALLATION REPO <br /> Date://"6/d�c Z <br /> CONSTRUCTION <br /> Premise Address: 2 r Total Depth <br /> Well No.:/Jr� 3 �� y Screen Length (from) U (to) <br /> Filter Pack (from) (to)— — <br /> Inspector: Bentonite (from) / (to) ---------' <br /> Grout (fro �(to) <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> ,,� ��"" Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: GS UCOr�'i <br /> Driller: 4 <br /> I TT casing <br /> ^^ // <br /> ConsultantlYC�E height <br /> Geologist_&n,,'�d —QV-f <br /> ABOVE-GROUND <br /> CO&PLETION CHRZS -BOX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surlace <br /> Distance to sewer line (.� k-- orart <br /> Domestic well on site - ( y n `� <br /> If yes, location and distance - fl <br /> ft It. <br /> a <br /> = m <br /> = m <br /> SAMPLING a <br /> '/ dotted — c <br /> Holding Temperature_Y eL aac'ion <br /> Method _ V,VI)i pad� <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> Yp N. _ <br /> SPOILS TM <br /> Storage Method Vv <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Locationt/fV(,/ <br /> Casing type <br /> Blank '-o ft. Screen ?-�b g, <br /> GROUTING - Slot size ©.02J0 <br /> Bags cement <br /> Depth to water �' Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Filter Pack type/siz <br /> Installation Method Surge Block: - (yn <br /> Quantity Installed <br /> Discussed with geo gist-. - �' n ) <br /> EH 29 29 <br /> Type of method �./ <br />