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100NITORING WELL INSTALLATION REPOni <br /> Date: 11-1(0,06 CONSTRUCTION <br /> Premise Address: ©��• � Total Depth 61 <br /> J Screen Length (from) / (to)�_ <br /> Well No.: /►i' / 2, Filter Pack (from) (to) _ <br /> Bentonite (from) 57 (to) Ss. 7 <br /> Inspector: Grout (from) 53 7 (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ /,- �- <br /> Driller: �(�X�I 7, t 'Z'4f casing <br /> Consultant <br /> I height <br /> Geologist / .�� _ T <br /> ABOVE-GROUND <br /> COMPLETION CHRZ Y-BOX <br /> PLETIO <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line J�o grout <br /> r <br /> Domestic well on site - (y <br /> If yes, location and distance - ft. <br /> ft. <br /> n. <br /> = m <br /> — o <br /> SAMPLING slatted �' <br /> 0 <br /> "c'don — <br /> Holding Temp rature41 GO 0) <br /> Method cru 35-f r <br /> Screening Method <br /> Tracking Sheet -(17 n ) F <br /> SPOILS <br /> Storage Method,.4+1-- E LtKCt4t�( ��� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y(DI p <br /> Storage Location G-q iLi...ed to c t�� Su/�o+so� Casing type 2 1 5 " � 7 ve. <br /> Blank ft. Screen 3 ft. <br /> Slot size Qid <br /> GROUTING Bags cement Y,-f6 <br /> Buckets bentonite V411 — <br /> Depth to water " .35 `f 0 Bags sand/gravel /7z <br /> MixRatios 7 /t t 2 Filter Pack type/size 2--12— <br /> installation <br /> -/ZInstallation Method Surge Block: - (y 493 <br /> Quantity Installed -11-Z-P&TS Discussed with geologist: - (ycD <br /> Type of method <br /> EH 29 29 <br />