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)NITORING WELL INSTALLATION REPC <br /> Date: 1 ` CONSTRUCTION <br /> Premise Address: 3 C) Total Depth C / <br /> Screen Length (from) ;(D I (to) I,S <br /> Well No.: Filter Pack (from) 3 O --(to) <br /> Bentonite (from) J3 , (to) /I <br /> Inspector. Grout (from) It (to) <br /> Drilling rig type ^^ <br /> Permit No. 0 3� ' Auger O.D. <br /> Completion- Stove pipe/ ' ne bos circle one) <br /> Drilling Company*_ Y0� ��� '�-� <br /> Driller. IW�`� casing <br /> height <br /> Consultant (Y)A LV <br /> -WO <br /> GeologistAA, NO <br /> AWVE-GRCU <br /> CJhrPL_ci'JON G-ffiiSTY-30X <br /> CCMPL-=ncN <br /> SPECIAL PERMIT INFO. G=nd Sul=* <br /> grcut <br /> Distance to sever line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - h- <br /> = a <br /> SAMPLING 11or*d <br /> sec:cn —_ <br /> .n = <br /> Holding Temperature = __ ¢7f0� <br /> Method <br /> Screening Method "' _ <br /> .. <br /> Tracking Shcet - (y/ n) F <br /> =tt. __._.= - 3 tt. <br /> SPOILS <br /> ,�v� <br /> Storage Method SS MA'IERI`4LS/DEVELOPMENT <br /> Contamination Noted- (y/ a ' P <br /> Storage Location Casing type <br /> Blank i e ft Screen1 <br /> Slot size - <br /> GROUTING Bags cement <br /> -q Buckets bentonite <br /> Depth to water l) Bags sand/gravel <br /> Mix Rados Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 / <br /> k <br />