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)NITORING WELL INSTALLATION REPOT <br /> Date: e ' t ✓ ' r/ CONSTRUCTION <br /> Premise Address: ,�� VU C3V-VV k -- Total Depth 80 <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> r Drilling rig type <br /> Permit No. 5� 5 I I Auger O.D. I C, I.D. <br /> Drilling Company: <br /> ( -e J Completion - Stove pipe/christie box (circle one) <br /> Driller: f <br /> '�nyl� pct, 6Y)aw casing <br /> height <br /> Consultant so yl� � IV <br /> LIZel —qVT <br /> Geologist No ` X— -- <br /> t`�► <br /> ABOVE-GACUNO <br /> � �`� COtvPL_E7)0N COMPLC <br /> P nMPLr°T1CNCN <br /> SPECIAL PERMIT INFO. G=rd Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - ft. <br /> rJ �• 7�' <br /> O <br /> >• <br /> C <br /> SAMPLING <br /> aac1cn <br /> Holding Temperature = gravd pack <br /> Method I V I LA, �p <br /> Screening Method r __ <br /> Tracking Sheet (y/ n ) _ <br /> -45 <br /> SPOILS T M <br /> Storage Method pf MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location Casing type_ <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> x rr Buckets bentonite <br /> Depth to water "J Bags sand/grawl <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ a ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br /> LU C&YVYU +Cc� ':Z� 'L W �Gi vvtQ �b E he (C . � <br /> k- W&,e Com w �L� �dz <br /> ussed lLdt'kv�- I-V <br /> 057/ <br /> �&'j . <br />