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WNITORING WELL INSTALLATION REP* <br /> Date: �Z N/!D /J�/L CONSTRUCTION <br /> Premise Address;// �TIS� A/Y Total Depth 1,1,5 <br /> Screen Length (from) 116 (to) JD � <br /> Well No.: Filter Pack (from) 17. 5 (to) /0 9 <br /> Bentonite (from) lD 3 (to) !o 0 <br /> Inspector: Grout (from) /0 (to) fZ <br /> Drilling rig type <br /> Permit No. �iLO 3� Auger O.D. I.D. <br /> I/ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: h <br /> Driller: rer=oond <br /> Consultant 4� ' �`�""'� COMPLETIONCOMPLETIONSPECIAL PERMIT INFO -- <br /> /✓/�" grout <br /> Distance to sewer line <br /> Domestic well on site - �n <br /> If yes, location and distance - �' a� 1, !D3 ft. <br /> — m <br /> = o <br /> = m <br /> _ c <br /> SAMPLING slotted <br /> asc5on = <br /> Holding Temperature = 5n,�Pa,* <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> �ft. <br /> SPOILS <br /> Storage Method Alid b-4'0( MATERIAIS/DEVELOPM/ENTT Q <br /> Contamination Noted - (y/ n ) A' O ?j 0�t�t "7o <br /> Storage Location Casing type <br /> Blank /65 ft. Screen ZO ft. <br /> Slot size -6;po <br /> GROUTING Bags cement <br /> Buckets bentonite SCJ d 5 <br /> Depth to water ��fl Bags sand/gravel 0 <br /> Mix Ratios Filter Pack type/size '} <br /> Installation Method Surge Block: -<37n ) <br /> Quantity Installed Discussed with geologis (y<n <br /> Type of method (( ��— <br /> EH 29 29 <br /> 0 <br /> /7-/210/?,Di 0 <br />