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NITORING WELL INSTALLATION REPO <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: Total Depth O <br /> ' Screen Length (from) '� `(to) <br /> Well No.:—.-.- W Filter Pack (from) (to) <br /> Bentonice - (from) {to) 1 <br /> Inspector: c-�C°-� �" Grout , (from) (to) �-- <br /> Drilling rig type i <br /> Permit No, Auger Ob. I f <br /> Completion - Stove pip u istie o (circle one) <br /> Drilling Company-_. il ,a�v tCQ.�R�ru� <br /> Driller• ,F <br /> V-O'i-3 1,J14:(a5sT3a - � casing <br /> height r: w f <br /> Consultant <br /> Geologist - 122LIAL - <br /> - ABOVE-GF�CUND CHFiX, <br /> CONFLETION <br /> CCMPLETICN n <br /> SPECIAL PERMIT TNFO. Ground Surface <br /> Distance to sewer line Z60 <br /> Domestic well on site <br /> If yes, location and distance - <br /> SAMPLING <br /> soccn <br /> Holding Temperature N <br /> Method e C-� �`�P <br /> ack <br /> " P <br /> Screening Method !a - <br /> Tracking Sheet -On ) <br /> n } - <br /> 1' 1 r `ft. <br /> 2— — <br /> SPOILS <br /> Storage Method 556A'(- 1 I * :5 RASV MATERIA gMEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location Casing type 4 :9 <br /> Blank 2z ft. ,Screen f ft. i <br /> Slot sizeGROUTING Bags cement_- (D _ <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel. - ,a _• <br /> Mix Ratios__ ( GFrtS Filter Pack type/size <br /> Installation Method ' ) Surge Block: - ( y/ n } <br /> Quantity Installed , Discussed with geologist: - (y/ n <br /> Type of method <br /> EH 29 29 <br /> � 9 i <br />