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0 e w MONITORING WELL INSTALLATION REPO <br /> Date: /Z I2�� - CONSTRUCTION <br /> Premise Address: 3g &j2. J' .Z; _ Total Depth <br /> Screen Length (from) ([o) ! X > <br /> Well No.: ��� Filter Pack (from) (to),Lh <br /> Bentonite (from) 4 (to) « - <br /> Inspector: Grout (from (to) 3 <br /> Drilling rig type <br /> Permit No. "1 " I Auger O.D. � I.D. y <br /> C -e Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: -> C r�J�a� , <br /> l' <br /> Driller: c casing <br /> // // ��� height <br /> Consul[ant��IL ` <br /> Geologist . Pt Ir-! I AgpyE-GRCUND <br /> COMPLETION Ci COMPLETION COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground S�'� <br /> Distance to sewer line [U'AZ grout <br /> Domestic well on site - (y/n) �_.ft. <br /> If yes, location and distance - h, <br /> tt. <br /> = m <br /> = m <br /> - c <br /> SAMPLING slorai <br /> aac9cn — <br /> Holding Temperature Y = Sraysl paac <br /> Method <br /> ScreeningMethod <br /> yr _ <br /> Tracking Sheet -'( Y 7 n) :.T <br /> tL <br /> SPOILS LL n <br /> Storage Method /17 sou e/y MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - n ) <br /> Storage Location 6h. Casing type `I <br /> Blank__Z O h. Screen ZO ft. <br /> Slot size <br /> GROUTING Bags cement ie < _ <br /> Buckets bentonite <br /> Depth to water /I Bags sand/gravel D' > <br /> Mix Ratios_ Filter Pack type/size <br /> Installation Method Surge Block: - ( y tt <br /> Quantity Installedi�� _ /r, J Discussed with geologist: -ry7 n ) <br /> Type of method <br /> EH 29 29 <br />