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MONITORING WELL INSTALLATION REPO• <br /> Date: I I I fl L I , / CONSTRUCTION <br /> Premise Address: v4 ti s �`r Total Depth <br /> A.•- �j �6 ! Screen Length (from) (to) <br /> Well No.: AW22 D t/ Filter Pack (from) (to) <br /> Bentonite (from) (to) SO <br /> Inspector: Grout (from) S l (to) o <br /> yJ CL�C� Drilling rig type E 75 <br /> Permit No. !� / ✓ Auger O.D. � I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: n� KA C + casing <br /> 41 height <br /> Consultant L6< <br /> Geologist - T <br /> ABOVE-GROUND <br /> ii <br /> COMPLETION ( <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line /-156 7roul <br /> Domestic well on site - (y A�n) $I . ft <br /> If yes, location and distance - p S 3 n• <br /> �ft. <br /> = o <br /> _ <br /> SAMPLING elc ted _ j 8 <br /> sacdon <br /> Holding Temperature = - VIVI, <br /> Pack <br /> Method <br /> Screening Method = `: <br /> Tracking Sheet - (y/ n ) <br /> ft. LN ft. <br /> SPOILS <br /> Storage Method B >` `� U'-al— MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Pvc <br /> Storage Location Casing type <br /> Blank Tv—ft— Screen ft. <br /> Slot size 01 n' <br /> GROUTING Bags cement <br /> Buckets bentonite I �U <br /> Depth to water 9 U- Bags sand/gravel YSo <br /> Mix Ratios Filter Pack type/size 7-12- <br /> Installation Method Surge Block: - (y t7n) <br /> Quantity Installed Discussed with geojo-jgist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> , / <br />