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INITORING WELL INSTALLATION REPO <br /> Date: Z4'X"' L �Z CONSTRUCTION <br /> Premise Address: TD U D . ! tax, Total Depth 20 <br /> Screen Length (from) Zd (to) /0 <br /> Well No.: �/ Filter Pack (from) ZO (to) 9' <br /> Bentonite (from) (to) - S <br /> Inspector: Grout (from) (to) <br /> p 2 Drilling rig type d"R E 5 <br /> Permit No. <br /> Z' 2"7 -3 7� Auger O.D. /b� I.D. 7 S� <br /> ��� ,/ ,Z� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 7� <br /> Driller: casing <br /> /1 height 1' <br /> Consultant <br /> Geologist / LACI ~ -GROUN <br /> MPLETION CHRISTY-SOX <br /> COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/0 ft• <br /> If yes, location and distance - <br /> fD ft _ <br /> m <br /> I = o <br /> 0 <br /> slotted _ <br /> SAMPLING aac9on <br /> Holding Temperature /X-e Sfiye4 F <br /> ack <br /> Method 10A 141" <br /> Screening Method —AVO O /R <br /> Tracking Sheet - y)/ n ) <br /> Z o �• �>� — Z O ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted -T y/ n ) <br /> Storage Location OX /yrs Casing type <br /> Blank 1 O ft. Screen /o ft. <br /> Slot size 2— <br /> GROUTING <br /> GROUTING Bags cement 2 <br /> Buckets bentonite 7 3 <br /> Depth to water ~'lL Bags sand/gravel --� <br /> Mix Ratios Z LleipO 'v� /S —�Gex- Filter Pack type/si e <br /> Installation Method Surge Block: - n <br /> Quantity Installed Discussed with geologist: - y n ) /e <br /> Type of method -�.i <br />