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('4NITORING WELL INSTALLATION REPO:, <br /> Date: fA�5 CONSTRUCTION l � jl1_ x� <br /> Premise Address ( ,�~ N _ (j'/ `�` ` Total Depth' t 1 <br /> ..� <br /> Screen Length (from) bl G (to) S <br /> Well No. �'; ' Filter Pack (from) ego ' <br /> S2<STm <br /> ' Bentonite k . (from) �' (to)Inspector: ��,a�� .4 - Grout, • (from) 3 ` (to) d _ <br /> Drilling rig type <br /> Permit No. Q o I V 7d f` ' #Auger O.D. TJD <br /> h <br /> .� Completion - Stove pip Christie ba (circle one) <br /> Drilling Company: <br /> Driller. ( J'l.l casing <br /> height <br /> Consultant <br /> W7T <br /> Geologist X,Q�J �U /J. r �- <br /> JIBOVE-GACUND # CFRZ Y4OX <br /> 0OWLET10N COMPLET3CN <br /> SPECIAL PERMIT INFO. ` ' ` i`" t. , 'G=rd d Surfs s <br /> .�� <br /> Distance te <br /> se' line <br /> Domestic well on site - (y/n) <br /> If <br /> yes; location and distance - fL <br /> t ` <br /> +V 0 <br /> V <br /> SAMPLING r. - :Iasi _ <br /> Holding Temperaturepack <br /> S� ' <br /> Method /Ca_ I-AP .ea* i Le/' ._ gra� <br /> Screening Method ^ /7 VA _ _ ^�• <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method . SJ7e " S�dC�-�jIP� "' -- MATERI8LS1DEVEi,OPMENT <br /> Contamination Noted - (y/n } , , <br /> Storage Location ' Casing type yG <br /> Blank S '— D ft. Screen.2 –S ft. <br /> Slot size da+ <br /> GROUTING "Bags cement <br /> Buckets bentonite <br /> Depth to waterfJfCi�`,r4 4ABags sand/gravel 3 /Vd?v 1kr&4111 -- <br /> Mix Ratios77— "-" Filter Pack type/size <br /> Installation Method . 5 _ 0 Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> –Type of method + <br /> EH 29 29 _ v <br />