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OONITORING WELL INSTALLATION REPG <br /> Date: /� , 9. Zo <br /> CONSTRUCTION <br /> Premise Address: Total Depth J 5 <br /> Screen Length (from) S (to) 30 <br /> Well No.: 15a)' ZA 3, f, _ Filter Pack (from) 5'S (to) 2� <br /> Bentonite (from) 28 (to)� . <br /> Inspector: Grout (from) (to) 1 <br /> 86 Drilling rig type <br /> Permit No. Auger O.D. /L I.D. <br /> �� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: '4'e e/-L— casing <br /> height <br /> Consultant 1 A6,5- <br /> Geologist <br /> 6CGeologist <br /> ABOVE-GROUND CHAMW-aox <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground SUN" <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y n 215 n, <br /> If yes, location and distance - 3D S n' <br /> = m <br /> O <br /> _ O <br /> C <br /> SAMPLING slatted _ �' <br /> an <br /> Holding Temperature = gravel pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS / Q /- <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Note <br /> Storage Location -Ati Y ��t Casing typeYe,a- <br /> / (0 <br /> Blank <br /> 3• ft. Screen 2 :)—IL. <br /> Slot size — <br /> GROUTING Bags cement <br /> Buckets bentoni!eCa <br /> Depth to water = '� Bags sand/gravel /C0 /b S4 /6oO LG <br /> Mix Ratios !/ Filter Pack type/size 43 ANAW afcc44 " <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed SS Discussed with geologist: - (y Q <br /> Type of method <br /> EH 29 29 <br />