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t + <br /> + _ (7JNITORING WELL.INSTALLATION REPG . <br /> 9� <br /> Date: CONSTRUCTION <br /> Premise Address: (- Total Depth <br /> Screen Length .(from)- (to) Co S <br /> Well No.: Filter Pack (from) (to)�,� <br /> Bentonite = ' (from)' (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 2's <br /> - Completion - Stove pi /christie (circle one) <br /> Drilling Company: r :. <br /> Driller: �Q G� �tb 61T casing <br /> T height'. <br /> Consultant �, <br /> Geologist ABOVE-GROUND <br /> OOMPLEf 10N C�WISTY-eOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO.Surfacs <br /> +� grout <br /> Distance to sewer line / <br /> Domestic well on site - (y nft- <br /> If yes, location and distance - ft. <br /> ft. <br /> yn <br /> s <br /> SAMPLING <br /> sa cn <br /> Holding Temperature c ." <br /> gr'vsl Pack <br /> Method <br /> Screening Method "' = <br /> Tracking Sheet n ) <br /> ft. --ft. <br /> --ft. <br /> SPOILS <br /> Storage Method f� MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - {y/ j�2 p QVC <br /> I� Storage Location l f /3ax W2,Ldi Casing type <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 2 Filter Pack type¢�ize <br /> Installation Method Surge Block: - yam'/ n ) <br /> Discussed with geologist: - �,.n ) <br /> Quantity Installed "' - <br /> Type of method -7Xt1<,tL <br /> EH 29 29 ~ <br />