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00NITORING WELL INSTALLATION REPOn'C <br /> Date: /-0 - o 7 �A�/�� CONSTRUCTION <br /> /�� <br /> Premise Address: (OOd 0/. /�*4v Total Depth <br /> A Screen Length (from) g!5 (to) <br /> Well No.: �1O/� Filter Pack (from) 85 (to) I <br /> n / Bentonite (from) 71 (to <br /> 4 )� <br /> Inspector: ,4A- Grout (from) (to) O <br /> �� Drilling rig type S <br /> Permit No. T Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller:_ �� � casing <br /> A0height <br /> height <br /> Consultant- - l/�'/c <br /> GeologistylOLAI ;I_ , <br /> T <br /> ABOVE-GROUND CiiA1STY BOX <br /> OOMPLEfION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAact <br /> Distance to sewer line SO grout/r <br /> Domestic well on site - ( y (91 6 tt <br /> If yes, location and distance - <br /> tt. <br /> tt. - <br /> = m <br /> = m <br /> — c <br /> SAMPLING slotted _ c <br /> an = 8 <br /> Holding Temperature - iavol Pack <br /> Method <br /> Screening Method r <br /> Tracking Sheet - ( y/ n ) F _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank-----If ft. Screen ft. <br /> Slot size . 0/0 <br /> GROUTING Bags cement Z 517 .e4,'.- <br /> Buckets bentonite /�2 <br /> Depth to water ' 31 Bags sand/gravel <br /> MixRatios 4' Filter Pack type/size 2 /2 <br /> Installation Method 0ge Surge Block: - (y <br /> Quantity Installed $5s5tVID Discussed with geologist: - (y n) <br /> Type of method <br /> EH 29 29 <br /> �1'r*7 i4'wlmA (e rg <br />