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*ONITORING WELL INSTALLATION REPOnO <br /> Date: /Z2-7/�0 CONSTRUCTION <br /> t <br /> Premise Address: /00 Gf/ � O Total Depth <br /> �nLL Screen Length (from) D (to) <br /> Well No.: l7J"� Filter Pack (from)_ b.,� �(to) 7 to /2- <br /> Bentonite (from) SG%2 (to)� <br /> Inspector: Grout (from) (to) <br /> �� OD,/�,�s� Drilling rig type �E S <br /> Permit No. 7` Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box circle one) <br /> � <br /> Driller: -Ax�� /" `� casing <br /> height <br /> Consultant Lill <br /> Geologist <br /> ABOVE-GROUND CHAISTY-8o <br /> COAFLEiION <br /> N <br /> SPECIAL PERMIT INFO. Ground SuAacs <br /> Distance to sewer line S6 grout <br /> Domestic well on site - ( y ft <br /> If yes, location and distance - {t <br /> /—ft. <br /> _ o <br /> = m <br /> o <br /> SAMPLING dotted <br /> on <br /> Holding Temperature <br /> Method V = P <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> 66 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) it <br /> Storage Location Casing type <br /> Blank 5:F- ft. Screen 3 ft. <br /> Slot size •0)0' <br /> GROUTING Bags cement '-'-10 " <br /> Buckets bentonite j tcP" <br /> Depth to water = 3D Bags sand/gravel <br /> Mix Ratiost 5 .�A"X Filter Pack type/size <br /> ethod Z <br /> Installation McVke d� � Surge Block: - (y n ) <br /> Quantity Installed Discussed with geologist: - (y n <br /> Type of method <br /> EH 29 29 <br /> 11111 <br /> 1%% �b <br />