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&NITORING WELL INSTALLATION REPO* <br /> Date: CONSTRUCTION <br /> Premise Address: T a4n, �✓1 Total Depth ') 5 <br /> —� Screen Length (from)- �_(to) S' <br /> Well No.:/�(N ZS Filter Pack (from) ZS (to) __ <br /> Bentonite (from)--4 z .S' <br /> Inspector. Grout (from) ? 5 (to)n b'4 � <br /> Drilling rig type Ll U <br /> Permit No. Auger O.D. <br /> S Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: SC <br /> Driller: V41f casing <br /> height <br /> Consultant <br /> Geologist4MC-Lc vi <br /> ABOVE-GRCUND Qlst TY-sox <br /> OOkVLE'rCN COMPLETION <br /> SPECIAL PERMIT INFO. Ground 9�xa 4 <br /> Distance to sewer line grout <br /> Domestic well on site - ( y On <br /> If yes, location and distance - tt, <br /> • tt. <br /> — o <br /> SAMPLING dorsi <br /> axion .F = <br /> Holding Temperature <br /> Method <br /> Screening Method 0 <br /> Tracking Sheet - y n ) x <br /> n. = tt. <br /> SPOILS <br /> Storage Method CJS a&61-4 MATERIALS/DEVELOPMENT <br /> Contamination Noted • (Ly n q- Lr/ <br /> Storage Location Ok L� Casing type <br /> Blank ft. Screen ft. <br /> Slot size 02 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ff Bags sand/gravel b <br /> Mix Ratios/t,mof' ce— Filter Pack type/siz <br /> Installation Method �7 Surge Block: - ( y n L <br /> Quantity Installed « Discussed with geologist: (y�n ) <br /> Type of method <br /> EH 29 29 <br />