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MONITORING <br /> NITORING WELL INSTALLATION REPO <br /> Date: 1�(y0 / CONSTRUCTION <br /> Premise Address: 6 Total Depth 6D <br /> / Screen Length (from) (00 (to) So <br /> --s <br /> Well No.: <br /> t <br /> �'/ v Filter Pack (from) 60 (to) <br /> Bentonite (from) (to) ' <br /> Inspector: Grout (from) 44,V (to) b <br /> Drilling rig type C4v-c <br /> Permit No. � 5LS5(o Auger O.D. $ I.D. <br /> ��� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ <br /> Driller: f ��k c f casin <br /> height <br /> Consultant 9 1 <br /> T <br /> Geologist —7 <br /> ABOVE-GROUND <br /> COMPLETION CNAISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground S rf'ce <br /> Distance to sewer line ? oro <br /> ut I I <br /> Domestic well on site - (y •q tt, <br /> If yes, location and distance - <br /> — a <br /> = m <br /> — o <br /> _ <br /> _ <br /> — c <br /> SAMPLING dotted = 8 <br /> section <br /> Holding Temperature ,T, e1 paw <br /> Method =_ <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) ff � <br /> J(ISLtt. = tt. <br /> SPOILS / n <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type <br /> Blank h. Screen I� ft• <br /> Slot size <br /> GROUTING Bags cemen l <br /> r I Buckets ben ntte '� Z- <br /> Depth to water 4� Bags sand/gravel C <br /> Mix Ratios 8-R Gast 4T` + 3o Filter Pack type/size Zt Zy- <br /> Installation Method A2« i. p-u� Surge Block: - (y� <br /> Quantity Installed 55 SU —`� Discussed with geo ogist: - (yC <br /> Type of method <br /> EH 29 29 11 <br /> 12�A-41 <br />