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WNITORING WELL INSTALLATION REP* <br /> Date: �4/�� lZ�7/2V/ V CONSTRUCTION <br /> p T, / <br /> Premise Address: /27 <br /> ?4& N <br /> �� 46&4) Total Depth J7/' <br /> /,''/ Screen Length (from) 1Z� (to) of <br /> Well No.: 14� 'u� Filter Pack (from) 12-1 (to) 'I <br /> Bentonite (from)_ 29 _(to) <br /> Inspector: Gu—• Grout (from) (to) <br /> / Drillin,rig type <br /> Permit No. Otl tp 30p ),D. I.D. <br /> ion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: L cas 9 <br /> I �J I-hei-gh <br /> Consultant I�11/ <br /> t ��"(tea N /,, � f � �J . Ibl• 8 o COMPLEnON <br /> SPECIAL PERMIT �/ (� / /D 1 r ­2 Ground Swt'c' <br /> �,/A,/// proof <br /> Distance to sewer 1 9 <br /> h�'�'• ��• <br /> Domestic well on sL L/ 17it /�D ft. <br /> If yes, location and c ^ 5 _ ft. <br /> _ m <br /> — n <br /> SAMPLINGAval <br /> / <br /> " B <br /> Holding Temperature_ r7 pIV64 Pack <br /> Method <br /> Screening Method /� n <br /> Tracking Sheet - ( y/ n )_ /l (dyM�D',P �U'� , �.✓ Q <br /> SPOILS <br /> Storage Method ((( <br /> Contamination Noted - (y/ n ) rib le�)✓C <br /> Storage Location ZZ� ft <br /> GROUTING � <br /> ouckets bentonite ' "t <br /> Depth to water (O?� B-sp—sand/gravel $o <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Q Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - ( / n <br /> Type of method <br /> EH 29 29 <br />