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C�NITORING WELL INSTALLATION REPOi," Y ; <br /> Date: CONSTRUCTION <br /> : <br /> 2I �, f ! $ <br /> Premise Address ?-$ Total1,Depth. 3� y 5. <br /> Screen Length (from) , S (to) <br /> Well No,: Filter'Pack (from) 34, S[to} 19. 5 <br /> Bentonite (from) lz.6 (to) 1 D.5 <br /> Inspector: Grout` (from) (to) <br /> Drilling rig type CM G � <br /> Permit No. Auger;O.D. IE I.D. 3Jc� ► <br /> Completion !'Stove pipe/cluistie box (circle one) <br />! Drilling Company: � hQ�In(� r� �nV II'or1� <br /> Driller• l ckQ�L�` <br /> �+ casing <br /> C height <br /> onsultant O lCZ <br /> l <br /> Geologist r'L' �� �► <br /> ASO ROUND <br /> COMPLEmION C itSTY-80X <br /> 5 COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sudaes <br /> l <br /> Distance to sewer line i0 grout <br /> Domestic well on site - (y n <br /> j <br /> If yes, location and distance - « 5 <br /> SAMPLING <br /> � aac'acn <br /> Holding,Temperature `a ko u, ' <br /> Method I Lk -s <br /> Screening Method 0V1 — <br /> Tracking Sheet - n ) ` -- <br /> R. ...r.�.'.., iL <br /> 4 t <br /> SPOILS <br /> Storage Methods L�7� b c�5'IC- MATERIALS/DEVELOPMENT f <br /> Contamination Noted - /n ) '� . I� , <br /> Storage Location 6",S L I � <br /> 71 It <br /> ;! 2 ' VG <br /> Yll ^�h��5 ti+r1 CQBlank [� 14.5 ft. Screen a b ft. <br /> ' Slot size P 0 2 V <br /> GROUTING Bags cement II <br /> r Buckets bentonite <br /> Depth to water �' t�2 Bags sand/gravel <br /> Mix Ratiosa ac Filter Pack type/size <br /> Installation Method Surge Block: -', {y <br /> Quantity Installed Discussed with geologist: <br /> Type of mediod K6 <br /> EH 29 29 i. t <br />