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'VONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> al <br /> Premise Address: Total Depth <br /> Screen Length (from) 4-6 (to) a <br /> Well No.: 't'`J / Filter Pack (from) 3-7 -1 (to) 66 , <br /> _ <br /> f Bentonite (from) 3S ' (to) _ 3:3 <br /> Inspector: _ Grout (from) (to) 3 s <br /> Drilling rig type <br /> Permit No. Auger O.D. 2=/ -'_ <br /> I r[ r e Completion - Stove pipe/c (circle one) <br /> Drilling Company: ( `` 4 <br /> Driller: _ J t VY�01, casing <br /> casing <br /> yy�� height <br /> Consultant J 1 '4 <br /> Geologist.. -- <br /> t��- - ABOVE-GRCIJFID <br /> CQMPI.E710tJ CNAISTY-SOX <br /> cOMPU=N <br /> SPECIAL PERMIT INFO, Ground Sona" <br /> Distance to sewer line grout <br /> Domestic well on site - / n) 3 S . tt- <br /> If yes, location and dis ce - , t D tt. <br /> an M <br /> SAMPLING $loft" M <br /> 3QCICn <br /> Holding Temperature <br /> Method Ll. <br /> Screening Method V '"- — <br /> Tracking Sheet - (y/ n ) " <br /> SPOILS <br /> Storage Method w v MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/�j f( -P V <br /> Storage Location_ (L/ _- Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water k� _ Bags sand/gravel <br /> Mix Ratios / Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n } <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 <br /> D -0 ` Type of method <br /> �" <br />