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00NITORING WELL INSTALLATION REPO# <br /> Date:—/—/V-0 � �i,,// CONSTRUCTION p <br /> Premise Address: /DDD &/• /�/� Total Depth704W — 6 6 <br /> �/ 30 Screen Length (from) 6-69 (to) <br /> Well No.: I Filter Pack (from) (o(o (to) /s 1 <br /> � / Bentonite (from) 1. l (to) �,7 <br /> Inspector: Sts�aGG(/1/1tiQ Grout (from) S7 (to) -T <br /> 611 5� //>3/U Drillingrig type tt <br /> Permit No. r� (y.x_ er O.D. $ I.D. 7 2 <br /> Drilling Com �s/•/ 0 09�\ Completion - Stove pipe/christie box (circle one) <br /> Company: 4.0 <br /> J\ <br /> Driller: >Z casing <br /> height <br /> Consultant ,� 41 <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sudacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 574 <br /> If yes, location and distance - T ✓ n•e. <br /> 63 S n _ <br /> 0 <br /> 1#5SAMPLING slatted — c <br /> V: �a C7u uctlon _ S <br /> Holding Temperaturegravel <br /> `P <br /> Method _ P <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS 70 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) u <br /> Storage Location Casing type r <br /> Blank 63 h. Screen <br /> Slot size '010 <br /> GROUTING Bags cement 61 ' <br /> Buckets bentonite I <br /> Depth to water 3 Bags sand/gravel <br /> Mix Ratios 6d-e4 t Filter Pack type/size 2,10- <br /> Installation Me d— —p±- e!:' Surge Block: - (y n ) <br /> Quantity Installed 77pca Discussed with gen gist: - ( / n) <br /> Type of method <br /> EH 29 29 <br />