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'ONITORING WELL INSTALLATION REPO? <br /> Date:— CONSTRUCTION <br /> Premise Address: Total Depth e�� <br /> / / Screen Length (from) 0'G (to) 6 <br /> Well No.: L Lt fd5 J�1 (��, �� Filter Pack (from) , (to) <br /> Bentonite (from) yam/ (to) Z <br /> Inspector: Grout (from) Z (to)_4x— <br /> Drilling rig type & ± <br /> Permit No. 7 e1 Auger O.D. 8" I.D. <br /> Completion - Stove pipe/ (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant � —QV <br /> Geologist_l,C/, <br /> ABOVE-GFiCUND CNAfSTY480X <br /> COMPLETION COMPLEEMN <br /> SPECIAL PERMIT INFO. Ground Surfacs S <br /> Distance to sewer line <br /> Domestic well on site - (y ft. <br /> If yes, location and distance - ft. <br /> 0 <br /> SAMPLING �lorai <br /> sac'icn <br /> Holding Temperature `1 R,,,W Pack <br /> Method de— <br /> '-Q-Screening Method <br /> Tracking Sheet - (y/ n ) <br /> 76it. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - W(5:p .� <br /> Storage Location OY\- 75:4�, Casing type <br /> Blank ' ft. Screen <br /> Slot size o Z, <br /> GROU'T'ING Bags cement <br /> Buckets bentonite <br /> Depth to water �-33" Bags sand/gravel <br /> Mix RatiosJ Filter Pack type/size <br /> Installation Method �1'2'.�.�.w�j Surge Block: -6y ' ii—7 <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />