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ONITORING WELL INSTALLATION REPO <br /> Date: r1 CONSTRUCTION <br /> Premise Address: �� lt �� Total Depth 5� <br /> —7 Screen Length (from) S4 _(to) 4y <br /> Well No.: Filter Pack (from) 5 / (to)=�F— <br /> Bentonite (from) 42 (to)�_ <br /> Inspector. Grout (from) 3« (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. 'C`,ti t I.D. 5 <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant_ �L —QW7:F <br /> Geologist Cf/ ^"' r`;-P^^. '`� <br /> A9ovE-GacuND CHRISiY-BOX <br /> COMPLETION CCMPLEnCN <br /> SPECIAL PERMIT INFO. Orcund S�zN +�� <br /> Distance to sewer line to' QrotA <br /> Domestic well on site - ( y/ n ft, <br /> If yes, location and distance g, <br /> N,. <br /> i tl <br /> C <br /> O <br /> SAMPLING Blotted = � <br /> aacicn <br /> Holding Temperature o� _ Brawl padt <br /> Method A.el '. <br /> Screening MethodZ, _ <br /> Tracking Sheet - / n <br /> SPOILS <br /> Storage Method C1�. D> 6ytu-' MATERIALS/DEVELOAAENT <br /> Contamination Noted - v_Yn ) <br /> Storage Location O -[-L Y Casing type <br /> Blank y ft. Screen (O ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite S <br /> Depth to water1Cf Bags sand/gravel <br /> Mix Ratios cen F Filter Pack type . <br /> M4 <br /> Installation ethods ,� cn < Surge Block: - ( y n ) <br /> Quantity Installed j ia!; Discussed with geologist: - L y n ) <br /> Type of method <br /> EH 29 29 <br />