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iv.,-.4ITORING WELL INSTALLATION REPOr— <br /> Date: CONSTRUCTION z <br /> Premise Address: ��a- �' /y[�� Total Depth J <br /> ��� Screen Length (from) (to) <br /> 35 <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) Z� (to) 2- <br /> Inspector: Grout (from) -(to)� <br /> �p Drilling rig type <br /> Permit No. C= 0D 5 4 Auger O.D. g I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: C casing <br /> height <br /> —ev-F <br /> Consultant /K.C�,,//� �J k <br /> �(tea--r `" ._ <br /> Geologist n� ABOVE-GROUND <br /> COVFLFrCN CISTY-BOX <br /> U- COMPLET1CN <br /> SPECIAL PERMIT INFO. Ground Surfxa <br /> procrt <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) .� 2'� ft• <br /> if yes, location and distance - ft. <br /> Z5 ft. <br /> SAMPLING olct'.ad <br /> &ac:cn <br /> Holding Temperature = '8�Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet ( y/ n ) <br /> 5 ft. ft. <br /> SPOILS <br /> Storage Method �� MATERIALS/DEVELO <br /> PM <br /> /ENT <br /> Contamination Noted - (y/ n ) Casing e Z r V IL <br /> Storage Location g <br /> Blank Z ft. Screen to ft• <br /> Slot size D!D`` <br /> GROUTING Bags cement <br /> _ Buckets bentonites -- <br /> Depth to water y Bags sand/gravel /Z <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Z 59 Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />