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r-QONITORING <br /> WELL INSTALLATION REPII -- <br /> j S-1 <br /> Date: l CONSTRUCTION- <br /> . � <br /> Premiise Address: �1 �7bjjjAe4 G(,e Sok` Total Depth 7d •w <br /> Screen Length (from)j (to) <br /> Well No.: Filter Packl (from) <br /> Bentonite (from) (to) t <br /> E Inspector: <br /> Grout (from) (to) <br /> Drilling rig.!type <br /> Permit No. � Auger O.D. LD. <br /> Completion'- Stove pipe/christie box (circle one) <br /> Drilling Company: i <br /> i. <br /> Driller: <br /> casing <br /> height ` <br /> Consultant h <br /> Geologist T <br /> Ai80 -GRC`UND <br /> COh F°LETIDN CHR*rY-80XETI <br /> pyo I� COMPLON <br /> SPECIAL PERMIT INFO. ° Ground Sumac* <br /> Distance to sewer line Y`S '� jgrout <br /> , <br /> Domestic well on site - (y/n ) ft. <br /> ft.if yes, location and distance - ' <br /> K. <br /> 146 _ <br /> SAMPLING <br /> S � <br /> Holding Te perature' <br /> Method �/ — gr"W pack <br /> Screening Method 3b �,�� I' Oki) .r — <br /> Tracking Sheety/ n ) <br /> 171 <br /> SPOILS [D <br /> 5 <br /> Storage Method 15A," MAT ERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) ` <br /> Storage Location Casing type'l <br /> Blank I ft. Screen ft. <br /> Slot size II <br /> GROUTING Ba slceinerit 8$ 1.Z r. l - : (Z <br /> t Buckets.hentonite <br /> Depth to water Bags sand/gravel M <br /> Mix RatiosFilter Pack type/size <br /> Installation Method Surge Block - (y/ n ) <br /> Quantity Installed Discussed v"th geologist: - (y/ n) <br /> Type,of method <br /> EH 29 29 II <br /> l <br />