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ONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> r/ Z Screen Length (from) `/.> (to) <br /> Well No.: Filter Pack (from) :5.f (to)LT_ <br /> Bentonite (from) (to) ? <br /> Inspector. (Jr oP� Grout (from)?.7 (to) <br /> Drilling rig type <br /> Permir No. �- �� Cf i Auger O.D. ,'w" I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: SCS <br /> P <br /> Driller: i �� heg <br /> [f � gn4 <br /> ht <br /> Consultant 0�`-Q- N <br /> yar <br /> /1BOVEd,FCUND CHA <br /> COWLETION \� CObiISLEnON <br /> SPECIAL PERMIT INFO. >> Grourd Strlaci <br /> Distance to sewer line PRE <br /> OraE <br /> Domestic well on site 7( y�on ft. <br /> If yes, location and distance - ft, <br /> A a <br /> Y <br /> 11 O <br /> 1 � C <br /> O <br /> SAMPLING tlorad = E <br /> p 6 soeion — <br /> Holding Tem erature r M _ paval pads <br /> Method SS <br /> Screening Method (D _ <br /> Tracking Sheet - / n ) <br /> SPOILS <br /> Storage Method (Ivy- MATERIALS/DEVELOPMENT <br /> Contamination Noted - t yen ) ./ <br /> Storage Location Oti—Sje Casingtype T"lpttl ?— <br /> Blank ft. Screen_2L��_fr. <br /> Slot size 07 U <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel ZZ 5� <br /> Mix Ratios n.-"A ca,� Filter Pack type/size OZ <br /> Installation Method 4-1 4 _ ? Surge Block: - ( y n <br /> Quantity Installed A(,4 d3 <br /> Discussed with geologist: - n ) <br /> Type of method v <br /> EH 29 29 <br />