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0,10NITORING WELL INSTALLATION REP Of <br /> Date: j�/U F fl/��O�o r CONSTRUCTION q <br /> Premise Address: 2,3 -5 5- dTotal Depth / <br /> Screen Length (from) (to) Z <br /> Well No.: / '`� Filter Pack (from) 39 (to) <br /> Bentonite (from) 13 (to) I <br /> Inspector: Grout (from) (to) +2- <br /> Drilling rig type 84?1 H-> <br /> Permit No. DDT Auger O.D. /Z I.D. (o <br /> ��v �� � Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �7/!/�k��2:�"LG�"Fu-� <br /> Driller: �/��I -t / a (iy...� i c )iinh <br /> Consultant ,,��,,••-- --yy��," t � 1' <br /> tT <br /> FT —QW—f <br /> Geologists <br /> A80V&GAOUND CHRZIT7-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S�iC° + <br /> Distance to sewer line � grout <br /> Domestic well on site - ( y n <br /> If yes, location and distance - / / tt• <br /> Y n. <br /> = m <br /> — o <br /> — m <br /> SAMPLING slotted = c c <br /> to don '- <br /> Holding Temperature — `� = gnvelpack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet • ( y/ n ) 3p , <br /> SPOILS <br /> Storage Method A2MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) K�" C / tb <br /> Storage Location Casing type OG /" <br /> Blank to br%re)ft. Screen <br /> Slot size OLO <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water 7i7 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y CnD <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method _ <br /> EH 29 29 <br />