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L'1CiiONITORING WELL INSTALLATION REPO*, <br /> Date:_ 1 C8 �sj ZOO 21 CONSTRUCTION <br /> Premise Address: /�Ot� 'f�W4'uJ AOV Total Depth <br /> Screen Length (from) (to) /D <br /> Well No.: 6' Filter Pack (from) (to) <br /> Bentonite (from) (to) b <br /> Inspector: Grout (to) �- <br /> �f Drilling rig type <br /> Permit No. T T Auger O.D. I.D. <br /> Completion - Stove pipe/Christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND (ry-6ox <br /> CONFLETIO N D <br /> SPECIAL PERMIT INFO. Ground Su lw* <br /> 7 proc�t <br /> Distance to sewer line <br /> Domestic well on site - {y':D <br /> If yes, location and distance - ft. <br /> f� ft. ft. <br /> I _ m <br /> C <br /> SAMPLING alottad <br /> .¢ &*Mon <br /> Holding TemperaturegmvW pack <br /> Method aLt <br /> Screening Method OV" <br /> Tracking Sheet - n ) �] ' <br /> SPOILS <br /> Storage Method GLu -^ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (YYn ) �,22-C <br /> Storage Location OVLlum �p SGG�� Casing type <br /> Blank %0 ft. Screen 30 ft. <br /> SIot size 02,0 <br /> GROUTING Bags cement 3 <br /> r Buckets bentonite / <br /> Depth to water .7-3 Bags sand/gravel / 0 <br /> Mix Ratios / 7` 7 Filter Pack type/size <br /> Installation Method Surge Block: - (y C <br /> Quantity Installed 3 __ Discussed with geologist: - {y <br /> Type of method <br /> EH 29 29 <br />