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10NITORING WELL INSTALLATION REP01 <br /> Date: /�/ �X CONSTRUCTION <br /> Premise Address: vL!j A%� 0 65 S Total Depth 176 <br /> ,,,'/ Screen Length (from) O (to)_�_ <br /> Well No.: �ZS Filter Pack (from) U (to) <br /> Bentonite (from) / (to) <br /> Inspector: _ Grout (from) /Zr, (to) O <br /> 3L Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Completion - Stove pipe/christie box (circle one) <br /> Com/pony: �/� N/ <br /> Driller: /I // t cas g <br /> /`-�/� � (AtOONPLETION <br /> Z pyeig t <br /> Consultant // —EFV-f <br /> Geologist Zd-�Z�/ieVE-GROUNDCHMM-BOX <br /> CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line A//* PER <br /> grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - /56 <br /> ft. <br /> = m <br /> = o <br /> = m <br /> o <br /> SAMPLING dotted � <br /> Holding Temperature - graw pyo <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method g�'" w� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y� D �ir p 1 <br /> Storage Location Casing type 0 r) <br /> Blank /9d ft. Screen /0 fr. <br /> Slot size <br /> GROUNG Bags cement /2 // <br /> TI /o <br /> r Buckets bentonite 364of <br /> Depth to water = �3S Bags sand/gravel .2 <br /> MixRados / Filter Pack type/size Z-//Z- <br /> Installation <br /> - /zInstallation Method Stage Block: - (y n �-^� <br /> Quantity Installed 500 Discussed with geo ogist: - (y o <br /> Type of method <br /> EH 29 29 <br />