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`i�`v10NITORING WELL INSTALLATION REPO <br /> Date: ;- 2.01 A- CONSTRUCTION <br /> Premise Address: a Total Depth 14 <br /> Well No.: <br /> �� £ r Screen Length (from) (to) 45-- <br /> Filter Pack (from) (to) / <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) ! (to)�— <br /> D�l �� 2-- Drilling rig type <br /> Permit No. Auger O.D. f(-) I.D. (v <br /> Drilling Company: cG :// <br /> / j <br /> _ Completion - Stove pipe/christie box (circle one) <br /> �7Df <br /> Driller: /��-��� casing <br /> height <br /> Consultant � <br /> Geologist Zia L!e-� ! l' <br /> ABOVE-GROUND <br /> COMPL�RION CHRLM-80X <br /> SPECIAL PERMIT INFO. Grvurd Surf act <br /> Distance to sewer line grout <br /> Domestic well on site - ( y n �r <br /> If yes, location and distance - 1-3n <br /> ' — m <br /> r <br /> SAMPLING — ` � <br /> slotted = � <br /> sscton — <br /> Holding Temperature <br /> Method = VsN4 Pack <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) " _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) 21/ <br /> Storage LocationCasing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement 9 4 <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel MixRatios.Ratios `f Filter Pack type/ ' e <br /> Installation Method � Surge Block: -(Lan) <br /> Quantity Installed Discussed with geologist: - n ) <br /> EH 29 29 Type of method 6i�Q <br /> �Z/00 U p Aw <br />