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"'OrAONITORING WELL INSTALLATION REPT! f <br /> Date: � OI CONSTRUCTION <br /> Premise Address: /8/4 Total Depth <br /> Screen Length (from) 5 (to) <br /> Well No.: P'4' Filter Pack (from) (to) <br /> / Bentonite (from) (to) "S-a <br /> Inspector. Kir+ �� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion • Stove pipe/cluistie box (circle one) <br /> �f�`'``-t"'l <br /> Driller: casing <br /> I—F height <br /> Consultant� 'd <br /> Geologist <br /> ABCVE-GACl1ND <br /> OONFLETION C74i7SiOm <br /> SPECIAL PERMIT INFO, Ground Surras <br /> Distance to sewer line 4�--L grout <br /> Domestic well on site - (y/ n ) 1 7h It <br /> If yes, location and distance <br /> V' O <br /> O <br /> SAMPLING /Srr <br /> Bored <br /> 96clen = 8 <br /> Holding Tempe acute I 'G <br /> Method e>A,., la-A, <br /> Screening Method _— <br /> Tracking Sheet / n ) _ <br /> tt• tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) /I �� <br /> Storage Location Casing type <br /> Blank 3 h. Screen2g ft. <br /> Slot size,420 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water `�� Bags sand/gravel 61 <br /> Mix Ratios Filter Pack type/s' e <br /> Installation Method -LtA+�+r-- Surge Block: -'r / n ) <br /> Quantity Installed Discussed with—geologist: - r;/ n) <br /> Type of method <br /> EH 29 29 <br />