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NITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION ' <br /> Premise Address: 1 V11�1 al lob Total Depth <br /> ii Screen Length (from) (to) �S-S <br /> Well No.: Filter Pack (from) S (to) <br /> - . Bentonite (from)r, (to) <br /> Inspector. : Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I. <br /> 1 r t Completion - Stove pipe/ tie b (circle one) <br /> Drilling Company: `� �" �J <br /> Driller- L14o'U" V oaalnq <br /> height <br /> Consultant <br /> Geologist <br /> . ACOVE4FICUND 1 <br /> CH <br /> CONFLETiON mPuenoN <br /> coM�mc�r <br /> SPECIAL PERMIT INFO. +t Ground Smite ..� <br /> Distance to sewer line QracR <br /> Domestic well on site - (y -n (jam ft. <br /> If yes, location and distanc <br /> m , <br /> SAMPLING i sloted 1 <br /> sat3cn —' <br /> Holding Temperature <br /> Method '`'' —_ 72 1W W <br /> Screening Method P fp <br /> Tracking Sheet (y/ n ) <br /> it.�... . . ,. <br /> SPOILS <br /> Storage Method_C)LN , �i�c . �. MATERIAL_S_/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location ,v` Casing type �! <br /> M_ ,,�O 6^JLAY W114A �a�Qol," Blank ^- —ft. Screen ..,..�.... ft- � <br /> Slot size <br /> GROUTING '' Bags cement <br /> j Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/ ;el <br /> Installation Method Surge Block: - y/ n ) �� f <br /> Quantity Installed Discussed withgeologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br /> 1 <br /> I� <br />