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MONITORING WELL INSTALLATION REPO'# <br /> Date: / _G 7 CONSTRUCTION <br /> Premise Address: 1666W, 13-k L- Total Depth 6Z <br /> /O `^� _ ,� Screen Length (from) &7-.(to)� <br /> Well No.: Filter Pack (from)— (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) 3 <br /> (� Drilling rig type <br /> Permit No. ! 3(� CA419jg�r O.D. I.D. 7 i <br /> Drilling Company: <br /> RS / Completion - Stove pipe/christie box (circle one) <br /> Driller:—" Z casing <br /> height <br /> Consultant lid <br /> Geologist Dom"- W- <br /> ABOVE-GROUND <br /> OOWPLEiION &PLETn]CN <br /> SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer line of0"t <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> = m <br /> - m <br /> SAMPLING dotted = <br /> wc5on = <br /> Holding Temperature = F <br /> Method = <br /> Screening Method = '` <br /> — s <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type 2�� SCIS gd v p <br /> VC <br /> Blank ft. Screen 3 ft. <br /> Slot size o 1 D <br /> GROUTING Bags cement 9 <br /> Buckets bentonite 1112. <br /> Depth to water 31 Bags sand/gravel 2- <br /> Mix <br /> Mix Ratios fltz 917 -eSO Cx2 Filter Pack type/size 2,1 12 <br /> Installation Method Surge Block: - (y(DD <br /> Quantity Installed Discussed with geologist: - (y n ) <br /> Type of method <br /> EH 29 29 <br /> /- 7 0 7 <br />