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MONITORING WELL INSTALLATION REPO <br /> Date: �J N 7� CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) <br /> Well No.: a�U -I S Filter Pack (from) (to) !I— <br /> ("j �q Bentonite (from) (to) <br /> Inspector: I( FlAk Grout (from) -7 D (to) l.b <br /> P Dulling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - S ve pip christie box (circle one) <br /> Drilling Company: <br /> ca 4 <br /> Driller: bb he <br /> Consultant 1(,(�'lr\I('r-1'�� <br /> Geologist ���� z��> �gpygliACUND <br /> C.tiFi75T'Y-80X <br /> CCA'P CCMPt rICN <br /> SPECIAL PERMIT INFO. �� r4Surtxa �.j A507 <br /> grout <br /> D1STanCe Co Sewer line <br /> Domestic well on site - (y/ n ) -3— tt• <br /> If yes, location and distance - tt <br /> = a <br /> _ � a <br /> a <br /> — c <br /> o <br /> c <br /> SAMPLING 'socia I = <br /> 71%,W PWR <br /> Holding Temperature <br /> Method_ " <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ 'PV�n <br /> �it. <br /> SPOILS 3 5 <br /> Storage MethodMATERIALS/DEVELOPMENT <br /> i <br /> Contamination Noted - en4). Casing type b V� 7 <br /> Storage Location Blank i ft. Screen I�_� <br /> Slot sizee <br /> GROUTING ivags <br /> ant <br /> !ckentomte <br /> Depth to water V vel <br /> tka A Filter Pack typesize <br /> Mix Ratios <br /> Installation Method f Surge Block: - C y <br /> Quantity Installed TyDise of with geologist: - <br /> Type of method � <br /> EH 29 29 <br />