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- ONITORING WELL INSTALLATION REPG"_.__> <br /> f • <br /> Date: (q ' CONSTRUCTION <br /> Premise Address: (v D S - Ve-rT�U r �-� Total Depth: x <br /> - Screen Length (from) 36 -(to)__j <br /> Well No,:—m Filter Pack (from) 3n (to) , <br /> Bentonite (from) ' (to), <br /> Inspector: S Grout (from) (to) <br /> Drilling rig type <br /> 4 Permit No. Auger O.D. I.D. <br /> - c ` Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 5 egfy- r-� <br /> Drillers 06 ej i casing <br /> .�-.. <br /> V <br /> freight <br /> Consultants� . . <br /> 7/X <br /> Geologist -- <br /> ABOVE-GROUND c8st 7Y-SOX ' <br /> faOMPLETlON COMPLETION <br /> SPECIAL PERMIT INFO. S [a-L . Ground Surface <br /> Distance to sewer line �f = 1f�6Q grout <br /> r Domestic well on site <br /> If yes, location and distance <br /> J <br /> SAMPLING �.' _� eloro.i — c <br /> ' Holding Temp azure �,�packMethod <br /> s Screening shod <br /> n <br /> Tracking Sheet - (y/ <br /> _ _ IF _ 30 . . <br /> SPOILS _ ,L �j I.G evert(.;{ <br /> Storage Method � S �- MATERIALS/DEVELOPMENT. <br /> Contamination Noted - y/n ►1 <br /> Storage Location Casing type ! <br /> t Blank I'D ft. Screen 2L ft. <br /> Slot size <br /> 4 GROUTING � Z Bags cement Gl <br /> r ((� Buckets bentonite <br /> pe- <br /> Depth to mater I �'. Bags sand/gravel' <br /> Mix RatiosFilter Pack type/ ' e <br /> [ installation Method-/ Surge Block: - n ) <br /> Jon <br /> ' Quar tiry Installed Discussed with geolo ist: - n) <br /> Type of methodti./ <br /> bGK <br /> EH 29 29 <br />