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*%wONITORING WELL INSTALLATION REPO. <br /> Date:n/ zl l?'f CONSTRUCTION <br /> Premise Address: 3V2_fW- /�1�-4 8 r-W— Total Depth ZE / <br /> ,/ Screen Length (from) (to) <br /> Well No.: /'t �� Filter Pack (from) (to) <br /> p Bentonite (from. (to) <br /> Inspector <br /> Grout (from) (to) <br /> Drilling rig type PS <br /> Permit No._?o' Z3G 0 Auger O.D. 9 5� I.D. ?/ <br /> Drilling Company: ",{az Completion - Stove pipe e bo (circle one) <br /> _ ,__ sti <br /> Driller: &1- t4A— casing <br /> height <br /> Consultant(s 'i <br /> V" <br /> Geologist AB�i/E-GROUND . <br /> COMPLETION CHRISIY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. <br /> Ground Surface ... <br /> f <br /> Distance to sewer line gut <br /> Domestic well on site - (y AD _ ,-(�ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> p <br /> O <br /> O <br /> SAMPLING $iona <br /> aaction _ � <br /> Holding Tem erasure _ �� a"` �`�pack <br /> Method A_Z477_4 —_ <br /> Screening Method—P(l) <br /> Tracking Sheet y n ) <br /> ft. — I Fft. <br /> SPOILS <br /> Storage Method �b� MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) h �, <br /> Storage LocationDyL.— Casing type <br /> Blank ft. Screen ft. <br /> Slot size .G <br /> GROUTING Bags cement <br /> Buckets bentonite 1 <br /> Depth to water �d Bags sand/gravel <br /> Mix Ratios Filter Pack type e 7 <br /> Installation Metho Surge Block: -l`�' n ) <br /> Quantity installedr/y Discussed with geologist:�/ n ) <br /> Type of method i <br />