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MONITORING WELL INSTALLATION REP-Kr <br /> Date: 1 Ul a CONSTRUCTION <br /> Premise Address:/ Y4,', h( � / 1-0 " Total Depth <br /> Screen Length (from) (to) <br /> Well No.: cL� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> tnspector � Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I D <br /> Completion - Stove pip tie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. he; <br /> ♦Iff ♦ 1" <br /> Consultan <br /> Geologist <br /> ABCYE-GROUND Ct•fAtS�!-3aX <br /> CC& !FTSON C—#APL ZE CN <br /> SPECIAL PERMIT INFO. Ci=nd Sufi <br /> r <br /> Zrast <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n )If yes, location and distance - d- <br /> a <br /> SAMPLING :bccad = a <br /> wctcn <br /> Holding Temperature _` 71VO[Padc <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n ) <br /> 'L ♦ -� ♦ tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterer 2- S Bags sand/gravei <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block. - C y/ n ) <br /> Quantity Installed Discussed with geologist: - C y <br /> Type of method <br /> EH 29 29 <br />