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SNITORING WELL INSTALLATION REPO' <br /> Date:�IL LV9 CONSTRUCTION <br /> Premise Address: 3S Total Depth 0-1 <br /> I�`t <br /> Screen Length (from) 3_q,,-,, (to) <br /> Well No.: Al K) Z7 Filter Pack (from)_L' r/z (to) -3(4 _. <br /> Bentonite (from) 'f/�- (to) z <br /> Inspector. N1�4A,_O Grout (fro 2 (to) <br /> Drilling rig e <br /> Permit No. Auger O.D. 10 f4` I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> p�> <br /> Driller: l—w n casing <br /> U -- <br /> height <br /> Consultant 4C <br /> Geologist <br /> A80FLErIOND <br /> CON�LETION CNAtSTY-BOX ' <br /> CU:MMPLETICN_ <br /> SPECIAL PERMIT INFO. around S _ <br /> Distance to sewer line grout <br /> Domestic well on site - (y n _ft. <br /> If yes, location and distance - 1 <br /> Ft. <br /> ;ai = <br /> O <br /> SAMPLING Mora J <br /> o sedcn '- <br /> Holding Temperature �i = vivo,Pack <br /> Method <br /> Screening Method i� <br /> Tracking Sheet -i y)/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( n �I,PV& <br /> Storage Location Dom' Casing type <br /> Blank ft. Screens - fr. <br /> Slot size .0-'1 o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 8 S� <br /> Mix Ratios .4, . cam Filter Pack type/size A <br /> Installation Method oP _ Surge Block: - ( y/ n <br /> Quantity Installedd Discussed with geologist: - �y�/ n ) <br /> Type of method <br /> EH 29 29 <br />