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• M s r JNITORING WELL INSTALLATION REPOO <br /> y E a <br /> Date:_ LQ r Q' i CONSTRUCTION <br /> Premise Address: (�� L l(�LstLLPst.� F #; Total Depth 12 co <br /> Screen Length (from) , F w' -(to) „ <br /> Well No.: rJ Filter Pack (from) (to) <br /> Bentonite . n(from) (to) � <br /> Inspector: �• SC1J l_slrl�l�l� Grout (from) (to) 8.— <br /> Y Drilling rig,type ' -- r_�o cGe __' <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box;,(circle one) ' <br /> Drilling Company: � � �fv5 <br /> Driller'--- - �c mss' caoing'i <br /> c- s height '. a <br /> Consultants <br /> Geologists <br /> ' ABOVE-GRWND �a CHWiS"iY-8GX <br /> CpMPLETiON COMPLETION <br /> SPECIAL-PERMIT INFO. Ground 5urfacs ..-.�� <br /> t <br /> Distance to sewer line � � �r grout <br /> Domestic welI,on site - (y f. <br /> fL •* <br /> If yes, location and distance - - <br /> SAMPLING <br /> n <br /> Holding Temperature <br /> x sac�c �: <br /> Method cc �; pack <br /> Screening Method <br /> Tracking Sheet n ) _ <br /> Irk <br /> SPOILS <br /> Storage Method MATi~_RIALS,(DEVEI.OPMEN_ T <br /> Contamination Noted.- (y <br /> Storage Location t . � Casing type 40 <br /> Blank C'(o fL Screen au ft. <br /> slot size'r <br /> GRO[7TING Bags cement t <br /> r Buckets bentonite <br /> Depth to water S Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge,Block: - (41)n } <br /> Quantity Installed `` Discussed wifth800logist: -'(y%'n} <br /> t Type of method KnX�»i,) <br /> r <br /> EH 29 29 <br /> 3 <br /> . r e <br />