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iii NITORING WELL INSTALLATION REPOk <br /> Date: –Nnl // / CONSTRUCTION <br /> Premise Address: l7lq%6 �' Vk tCAB/. Total Depth <br /> Screen Length (from)—(to)— <br /> Well <br /> from) (to)Well No.: ?Pj) 7i Filter Pack (from)—(to)— <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> y/b A Drilling rig type <br /> Permit No. / Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller:"' / YTS' fi casing <br /> height <br /> Consultant T <br /> T <br /> Geologist _ <br /> A80VE-GROUND CHR:y–ry.BOX <br /> �/r pF � COMPLETION COMPLETION <br /> SPEC �,IIP� ( � Ground Sur( <br /> Dista /J/ Jz' 8I ��� Lrl r / grout <br /> Dome l ✓ `Q r' <br /> If yes, I C iZ5 ft. <br /> m <br /> SAMPLi �/ slotted _ <br /> wdon '^ <br /> Holding RavelPack <br /> Method_ <br /> Screening <br /> Tracking g �� / ✓l�yfTpC �s <br /> G 1y° <br /> SPOILS Z Z g <br /> Storage Method NIX LO ME T <br /> Contamination Noted - (y/ n ) 21I <br /> Storage Location Casing type <br /> Blank fr. Screen—LS--ft- <br /> Slot <br /> creenISft.Slot size .01.0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />