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�JNITORING WELT.INST TION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: 6 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: a" Filter Pack (froth) (to) G–7 <br /> Bentonite (from) `lEzti' <br /> (to) -5 <br /> Inspector. Grout (from (to) <br /> Drilling rig type - <br /> PNo. Auger O.D. LJL I.D. <br /> Completi - rove christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant,_ <br /> 7/4 <br /> Geologist LA -- <br /> ABOVE-GROUND C*FizW-80X <br /> COMPLETCN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfw* <br /> Distance to sewer line gfout <br /> Domestic well on site - ( Me <br /> -5� . ft. <br /> If yes, location and distan „ <br /> N <br /> 5-7 <br /> w5h <br /> SAMPLING mored — C <br /> sacticn <br /> HoldingTemperature <br /> pavW pads <br /> P <br /> Method =: — <br /> Screenino Method <br /> Tracking Sheet (y/ n ) <br /> P cam-. <br /> � �- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ - r+ V <br /> Storage Location Casing me <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING .. Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> MIX Ratios 4 Filter Pack type/size YW C <br /> Installation NYethA. Surge Block: - & n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> r U <br />