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wIONITORING WELL INSTALLATION REPOPff a� Z <br /> 6 Js jcaG <br /> Date: > �C:CJ CONSTRUCTION <br /> I <br /> Premise Address: 1 caro 6) AA?i `'I `� Total Depth �J <br /> ?it <br /> Screen Length (from) (to) <br /> Well No.: hA (,U'r ? Filter Pack (from) 4-0 (to) 3 <br /> Bentonite (from) N- (to)—S oT <br /> Inspector- ��� Grout (from) -e (to) y ' <br /> Drilling rig type <br /> Permit No. n Q ? 7 4s 2SG Auger O.D. I.D. <br /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: �,�r�-{ Op��'litc.% . <br /> Driller: rn casing <br /> r height <br /> Consultant SZrcSI �� V <br /> Geologist Ny" it <br /> ABOVEGRCOND C74ifSTY3pX <br /> COA4'L_�ffON CONUDt—CCT1CN <br /> SPECIAL PERMIT INFO. (3=nd$ula s <br /> Distance to sewer line grad <br /> Domestic well on site - ( y/ n ) ft <br /> If yes, location and distance - <br /> a <br /> FF SAMPLING <br /> tacicn <br /> cryHolding Temperature \ t e.k _ P� <br /> Method 16" (-1 <br /> Screening Method dDj l7 +" 7 <br /> Tracking Sheet -�9y n ) <br /> ft. <br /> SPOILS <br /> Storage Method_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y Cry) <br /> Storage Location irin -a-4-61 Casing type y PV'C <br /> Blank $3 ft. Screen h. <br /> Slot size D z C'J <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ^ S t Bags sand/gravel ti o <br /> Mix RatiosS czu'� n Cu ve SS PoCt�. Filter Pack type/size 2 <br /> Installation Method wati^, 1 Surge Block: - ( y/ n ) <br /> Quantity Installed ti Discussed with geologist. - (y/10 <br /> EH 29 29 Type of method <br />