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Sent By: HP LaserJet 3100; • 44; Dec-1 - 7:10AM; Page 2 <br /> ' 6NITORING WELL INSTALLATION REPO <br /> Date: 17/1 0� CONSTRUAN <br /> Premise Address: Total Depth <br /> Screen Length (from)�(to) <br /> Well No.: Filter Pack (from) ' (to) <br /> Bentonite (from)_fk<Rf•-(to) &0 <br /> Inspector: Grout (from) '2_' (to) 52 <br /> Drilling rig type <br /> Permit No. Auger O.D.. ''{�.�'j l.D. <br /> 11 Completion-Stove pipe/christie box (circle one) <br /> Drilling Company:_ L1 J li � aio/1 <br /> 1�1 <br /> Driller. Its OV casing <br /> QQ height <br /> Consultant �\ j <br /> r <br /> Geologist pn�'"' '" <br /> ABOVE-GROUND Ct6i M-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. �-' '�'� ��O`°and Svr1'°' "+ <br /> Distance to sewer line Oran <br /> Domestic well on site- ( y I n ) ._n. <br /> If yes, location and distance - (o I (0 01 IL <br /> J m <br /> SAMPLING sloltod - <br /> "Man ¢ = B <br /> Holding Temperature : gnvdpadc <br /> Method <br /> Screening Method , <br /> Tracking Sheet - (y/ n) 8 = <br /> n. <br /> SP S <br /> Storag <br /> e Method MATERIALS/DEVELOPWNT <br /> Contamination Noted- ( y/ n ) t k o Q L <br /> Storage Location Casing type <br /> Blank ft. Screen 3 F} R. <br /> Slot size n M <br /> GRPG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/grpvel <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 methiod <br /> EH 29 29 <br />