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I✓IONITORING WELL INSTALLATION REP1' <br /> Date: i CONSTRUCTION <br /> Premise Address: G`1C P� `r Total Depth <br /> Screen Length (from) (to) I I <br /> Well No.: god Filter Pack (from) 1'x,-1 (to) <br /> Bentonite (from) I n (to) 1 o 5 <br /> Inspector: Grout (from) 16 5 <br /> Drilling rig a (Lo <br /> Permit No. Auger O.D. qqzI.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: a LD <br /> Driller:. casing <br /> height <br /> Consultant I I V <br /> Geologisty" CAJ�Nkt T G-44W) J Oi5 T <br /> ABOVE-GROUND CHMM-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. td SuA 7- <br /> Distance to sewer linegrout <br /> Domestic well on site - (y ti.) CED- n. <br /> If yes, location and distance - p n, <br /> i11 n. _ <br /> 0 <br /> O <br /> Y" <br /> G <br /> SAMPLING tbntd <br /> /J� o <br /> � <br /> &*don $ <br /> Holding Temperature = pawl pads <br /> Method l3 i <br /> Screening Method i <br /> Tracking Sheet - (y/n ) 5 13 I <br /> EQ <br /> SPOILS 131 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type 3 cf,40 Y <br /> Blank 111 ft. Screen 1,0 fr. <br /> Slot size 2 <br /> GROUTING Bags cement D <br /> / Buckets bentonite 7 5 <br /> Depth to waters Bags sand/gravel 11.4,16 <br /> Mix Ratios Filter Pack type/size I C, <br /> Installation Method!VU pm Surge Block: - y n) <br /> Quantity Installed Discussed withlogist: - �J n) <br /> Type of methodyy <br /> EH 29 29 <br />