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NITORING WELL INSTALLATION REPOKC <br /> Date: ��/6 y CONSTRUCTION <br /> Premise Address: 151015 <br /> S• 7 � �' Or Total Depth <br /> �—screen Length (from) (to) <br /> Well No.: T Filter <br /> Pack (from) (to) � <br /> Bentonite (from) _ (to) <br /> Inspector: - Grout (from) (to) lIi <br /> Drilling rig type <br /> Permit No. `� Auger O.D.' I.D.— <br /> Completion <br /> .ACompletion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: <br /> / i/Lcasing <br /> „ <br /> height � <br /> Consultant h T <br /> Geologist )`d - ABOVE—GROUND T <br /> . C <br /> COMPLETION iiA1STY-BOX <br /> OMPLETION <br /> k . <br /> SPECIAL PERMIT INFO. Ground Surlwe <br /> w <br /> Distance to sewer line L grout <br /> Domestic well on site - (y/ n ) SO ft. <br /> If yes, location and distance - ft, <br /> ry rv. <br /> ' ' rvy. _'w�i '� 1. - ger = •_ _ - p <br /> SAMPLING �. �slotted <br /> section <br /> Holding Temperature _ W pack <br /> Method <br /> Screening Method L <br /> Tracking Sheet, (y% ntL <br /> ) h <br /> K is <br /> ZS = <br /> --SPOILS t� IN e , v' ,. -`"y <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y%n;); <br /> Storage Location R Casing type T Y <br /> Blank Zj0 fr. Screen / ft. <br /> X <br /> s i 'x4. -*,Slot size' 0.30 <br /> GROLMNG ;Bags cement� � A� <br /> qTa <br /> _ ;�. Buckets bentonite ' 2 <br /> 1 Depth to water' -'��/.' ' '1Z,,,, sBags sand%gravel <br /> Mix Ratios �'Filter Pack type%siz�e 3 <br /> w _ 'T e o ed with(y 10 <br /> Installation Method _Sure Bloc <br /> ^ Quantity <br /> Installed* �*e.' �-, � ��+ s t Discussed with geologist: - (y <br /> R s Type method <br /> EH 29 29 <br />