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"VONITORING WELL INSTALLATION REPOn`1 <br /> Date:,_ a�hIO(' CONSTRUCTION <br /> Premise Address: /� Total Depth �J <br /> Screen Length (from) (to) Z5 <br /> Well No.: �/ Filter Pack (from) 'L (to) 2,5 <br /> Bentonite (from) 3`Z (to) Y <br /> Inspector: Grout-CDur- (from) V/Z- (to) m uz _ <br /> Drilling rig type1ii,C-Sl <br /> Permit No. _ ��/ / Auger O.D. S I.D. <br /> 7 . Completion - Stove pipe/christie box (circle one) <br /> Drilling Com y:_ l� �_- --- <br /> Driller: casing <br /> height <br /> Consultant e • 6-- • 537 T <br /> Geologist T <br /> ABOVS-GROUND <br /> GOA�LETlON G�itSTY-BGX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 7 grout <br /> Distance to sewer line <br /> Domestic well on site - 61 n ) 3/y, ft. <br /> If yes, location and distance - 9 VY2, ft. <br /> ft. >; <br /> 4" m <br /> H^ O <br /> C <br /> SAMPLING w <br /> alottQd C <br /> * aeclon ry = <br /> Holding Temper are <br /> V&vW pack <br /> Method z <br /> Screening Method i <br /> Tracking Sheet - On ) <br /> SPOILS <br /> Storage Method 5�� /Lcc..� -_-_- MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n �-� <br /> Storage Location &40k '�'4'R"� Casing type !� <br /> Blank ,3 ft. Screen Za ft. <br /> Slot size t O b <br /> GROUTING Bags ce _ <br /> Buckets bentonite <br /> Depth to water /O Bags sand/gravel <br /> Mix Ratios 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 /> Ire,, .b <br />