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/ JA MONITOR.ING WELL INSTALLATION REPT..,L' <br /> Date: 4 1 CONSTRUCTION <br /> Premise Address: /� J f6 G St'I `T 't Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: K.A 6/I "� `� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ! Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> /,- <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ,�t� <br /> Driller: F17=1_1cas in9 <br /> _f t height <br /> Consultant 'd <br /> _qV <br /> Geologist <br /> ABOVE-GROUND CHS*TY_8OX <br /> OO&F LZrC N COMPLEnCN <br /> SPECIAL PERMIT INFO. (around Surface <br /> Distance to sewer line <br /> Orccrt <br /> Domestic well on site - ( y/ n ) ,ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> = m <br /> C <br /> SAMPLING <br /> tloc:w-i <br /> aucycn = <br /> Holding Tmperatu <br /> Oravd pacts <br /> Method 6A A," <<1 — <br /> Screenin;Method <br /> Tracking Sheet - / n ) <br /> ft. = fto <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />