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�t NITORING SWELL INSTALLATION REPO41 <br /> I: <br /> Date: �'^ t `y- CONSTRUCTION + <br /> Premise Address: n/� Total Depth > <br /> r* Screen Length.(from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to)— yal <br /> Inspector: , _ Grout (from) P5E5 f to) 9 <br /> .. _ x Drilling rig type G h nr F <br /> Permit No. Auger O.D. " I <br /> Completion - Stove pipe/ lrl27 box (circle ane) <br /> Drilling Company: , <br /> Driller: �v� Y� ' �' casing 4 V <br /> Consultant tc !' , height:C76 <br /> Geologist b gogL <br /> �. of ABOVE-GROUND � STY <br /> A� -8OX ' <br /> COMPLETION ' COMPLETION I <br /> SPECIAL PERMIT INFO. SWOMMMMMM16 around Sia <br /> Distance to sewer 55Iine N ,;, gfow <br /> Domestic well on site - (y n. <br /> if yes, location and distance - tt. <br /> �; AIM <br /> ft. <br /> ,j: : <br /> SAMPLING <br /> sods<lara Y — <br /> en <br /> Holding Tem era ture IICc I� .. , <br /> Method — <br /> Screening Method <br /> Tracking Sheet - y n) A -=z <br /> E; o TD <br /> SPOILS <br /> Storage Method ,,;, MATERIALSMMLOPMENT <br /> Contamination Noted - -4-• :Z--b 1935 <br /> Storage Location F Casing type a V <br /> Blank ft. Screen <br /> ., Slot size,_ <br /> GROUTING Bags cement ? <br /> ! Buckets bentonite L1 GDo [L' bQ!E� <br /> ... <br /> 41. <br /> Depth to water Bags sand/gravei <br /> Mix Ratios r Fr Filter Pack type% ize_ tZ <br /> Installation 4 s Surge Block: - n ) <br /> Quantity Installed , w Discussed with geolo ist: y n ) <br /> Type of method' � <br /> EH 29_29 <br /> JD <br /> VCL(j rr re li <br />