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NITORING WELL INSTALLATION REPOn. <br /> Date: ��ib �g CONSTRUCTION <br /> Premise Address: 17��d Gf/� U/R /y/G 1t 4 Total Depth ld <br /> ,,// Screen Length (from)--Z (to) <br /> Well No.: au-A- S Filter Pack (from) /3( (to) l< <br /> Bentonite (from) // (to) o <br /> Inspector: Grout (from) (to) 94*Z <br /> �J �QQ Drilling rig type �! <br /> Permit No. J // Auger O.D. I.D. <br /> `£ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: (� <br /> Driller: �� Z CeGround <br /> /27�GlilCp r 16/T <br /> QVT <br /> Consultant <br /> Geologist iG^' <br /> CHRIM-Sox <br /> COMPLETION <br /> SPECIAL PERMIT INFO. cv <br /> Distance to sewer line Q �2 r grout <br /> Domestic well on site - ( y n ) ft. <br /> If yes, location and distance - ft.o o ft. <br /> �� ft. <br /> _ a <br /> = m <br /> — m <br /> — r <br /> SAMPLING slotted _ <br /> taction — - <br /> Holding Temperature = gravel pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Z rz Ale- <br /> Storage <br /> Location Casing type <br /> Blank //6 ft. Screen <br /> ft <br /> /yI^ <br /> Slot size .0/D'r <br /> GROUTING Bags cement <br /> Buckets bentonite 6AY4 r 3 3U i <br /> Depth to water ^ D Z ��y Bags sand/gravel� 'f <br /> Mix Ratios /2- " �0 9f, t 7 Filter Pack type/size Z <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />