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Mr*TITORING WELL INSTALLATION RE.DORT <br /> Dare: z&4 5� �9 ?72 CONSTRUCTION <br /> Premise Address: U 6 �, _ Total Depth l <br /> � Screen Length (from) PY (to) 9 <br /> Well No.: Filter Pack (from) /`I (to) 7 <br /> Bentonite (from) 7 (to) S S <br /> Inspector: Grout (from) -5 (to) <br /> Drilling rig type �E S <br /> Permit No. 92-' 2- Auger O.D. 1-0- S<', I.D. oyy <br /> /V Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> lI casing <br /> Driller: 1, @K�LL height <br /> V <br /> ♦ i <br /> Consultant <br /> Geologist !/1 G% � A3OYE-GROUNDpJS?1'-30x <br /> per"L_TION CCMPL-"'i iCN <br /> Ground Stxfacs <br /> SPECIAL PEFLMIT INFO. <br /> gro(4 <br /> Distance to sewer line 4L ' <br /> Domestic well on site - ( y On 7 <br /> S�n. <br /> If yes, location and distance - <br /> = a <br /> — o <br /> SAMPLING tiacdon a'' <br /> Holding Temperature <br /> Method OK 4 <br /> Screening Method IVO OU — <br /> Tracking Sheet - y n ) _��• ♦ »� _ �� ft. <br /> SPOILS f <br /> Storage Method .e► �41 4W^"t4 MATEPRIALS/DEVELOPMENT <br /> Contamination Noted - ( y/moi << 5-c4 4o rJ <br /> Storage Location VVL Casing type <br /> Blank ft. Screen /0 ft• <br /> Slot size zp <br /> GROUTING Bags cement S <br /> Buckets bentonite 1 <br /> Depth to water Bags sand/gravel_ <br /> Mix Ratios / 2 6 Filter Pack type/sizer 3 G-S <br /> Installation Method Surge Block: - 0 n ) <br /> Quantity Installed Discussed with geologis : - *3 n <br /> Type of method __—� <br />