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+fONITORlNG WELL INSTALLATION REPc� T <br /> s , r <br /> Date: rj CONSTRUCTION <br /> !Premise Address: 3�. '� " " '" Total Depth ...a ; <br /> Screen Length (from) (to) <br /> Well. No.: .4 + + ,Filter Pack (from) �' (to) <br /> ', i w ." . ��` .. Bentonite s (from) - (to) <br /> . (to)InspectorGrout (from) <br /> ._Drilling rg <br /> k <br /> type L ' <br /> Permit.No. �— �� Auger O.DC.D. ' <br /> 7Completion -'Stove pipe/christie,box' (circle one) <br /> Drilling Company.'r�'7 LL y <br /> + <br /> Driller: 0 casing . 1 <br /> " <br /> he,ght <br /> Consultants rt <br /> 7/4 - <br /> Geologist <br /> . . _. _. AjOV 4RCJND n . _ G1Mm-aoX <br /> GO IPLETC N CCMPLEMN <br /> SPECIAL PERMIT INFO. -- R - Drourd Suiace <br /> Distance to sewer line - - grout - r <br /> Domestic well on site - (y/ n) �:.ft. <br /> If yes; location and distance - - - - fL - <br /> CY <br /> SAMPLING ii .. .. ..h aloft d w <br /> + (gyp sedcn <br /> Holding T peva VOL ¢,vd Pack <br /> Method A-9 — <br /> Screening Method no <br /> '['racking Sheet / n } ° k� <br /> k. <br /> .SPOILS. r, _ ., t �.. xti.._czs I - -. ) . <br /> Storage Method F , MATERIALS EVELOPMENT <br /> Contamination Noted A( -�- '�` ""'► <br /> Storage Location ' �_ „__ Casing type <br /> Screen ft. <br /> Y, <br /> _ - Slot size <br /> # Bags cement <br /> Bucke <br /> GROUTING ts bentonite <br /> Depth to water .�.�U _.Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method T _ Surge Block: - (y/ n } <br /> Discussed with geologist: - (y/ n ) <br /> �. Quantity Installed_.. , .__ T _ g g• .. . ._ <br /> Type of method <br /> EH 29 29 <br /> 4 <br />