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SONITORING WELL INSTALLATION REPS <br /> A2.Or•,R corxWC t� <br /> gtieS 1:30) <br /> Date: 13 • I '�+ CONSTRUCTION <br /> Premise Address: c( �s �n Total Depth <br /> �^\n1 � � 1 Screen Length (from) (to) <br /> Well No.: <br /> I v Filter Pack (from) (to) <br /> Bentonite (from)-(to)- <br /> Inspector: <br /> from) (to)Inspector: �n� 7( ✓�� Grout (from) (to) <br /> _ Drilling rig typeMO& rD <br /> Permit No. Auger O.D. I• <br /> I Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: \(\]V85 8 r <br /> Driller: �ok0 � o� � 4 casing <br /> Fshed iv height <br /> lQ o ty%-Q Q I�r <br /> Consultant._ LC�Q-_ 221 <br /> Geologist -� V✓1 � � ._ <br /> ABOVE-GROUND CHRISrY-BOX <br /> kvISF%A.o +- MSDC- COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) n. <br /> If yes, location and distance - n. <br /> 13 <br /> liO <br /> SAMPLING me <br /> T t YYY--V-L- slotted <br /> (o(a •Yptugl'o(¢. wc4on <br /> Holding Temperature grave Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> ' • Type of method <br /> EH 29 29 518 - 1,5-yAkj `oeZ �(kt&u l't <br />