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MCNITORING WELL INSTALLATION R °ORT <br /> Date: CONSTRUCTION <br /> Premise Address: Screen <br /> Total Depth r;70 �-- �D <br /> Screen Length (from) <br /> o Fuer Pack (from) (to) <br /> Well No.: �� <br /> 6r Bentonite (from) (to) <br /> Inspector: lt ` urv�l4 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> / Completiaa - Scove pipe/christie box (circle one) <br /> Drilling COmpany:� S645 — <br /> casinq <br /> Driller. �Frj-7 height <br /> 7 7 <br /> Consultant \\ <br /> Geologist !O ABC vEv^r7Cl:ND CHAI.S7Y-3CX <br /> ll7�SGYi/ C.)trf?'�i;CN C:.MAt=iICN <br /> ���Ground Su toes <br /> SPECI?L PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n tL <br /> If yes, location and distance - <br /> k = 3 <br /> e <br /> O <br /> tloaad <br /> SAMPLING tacdon <br /> Holding Temperature <br /> Method Gu i�{r�nGS <br /> Screening Method <br /> Tracking Sheet - (y/ n) t, � _ � tt• <br /> D <br /> SPOILS lvrl' GA� <br /> Storage Movl �ethod �!/� MA i-RIAIS�DEVELOPIyLFNT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location B1 fG Screen f[ <br /> Slot size , Db5' - <br /> GROLMNG Bags cement <br /> Buckets bentonire <br /> Bags sand/grave! <br /> Depth to water Filter Pack type/size <br /> Mix Rados_ <br /> Installadon Method Surge Block: - ( n ) <br /> Discussed with geologist: - n <br /> Quandry Insralled ) <br /> Type of method <br />