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OONITORING WELL INSTALLATION REPO• <br /> i9XDate: /,� , D/ '—' �O/ /(�, O/ CONSTRUCI'fON <br /> Premise Address: � L�j —( iii Total Depth <br /> /�I�� 3 Screen Length (from) <br /> Well No.: `� Filter Pack (from)_ 7 0 (to) 52 <br /> ���} Bentonite (f <br /> Inspectorrom) 5- (to) 5 <br /> . Grout (from) (to) f _ <br /> Drilling rig type e... 5'h,o -- <br /> Permit No. Auger O.D. q" <br /> 1. <br /> Drilling Company: �e pe/ t <br /> Completion - Stove pirtsae o. (circle one) <br /> /.'n � <br /> ng <br /> Consultant. <br /> 1711 <br /> heicasghtheightConsultant SG 01Geologist j�3 <br /> /ABOVE-GACUND <br /> CCNFL.`TION CHRZTY-80X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. ��Sexy 5 <br /> Distance to sewer line proof <br /> Domestic well on site - (y <br /> If yes, location and distance - S ft. <br /> �--�it• <br /> = a <br /> SAMPLING slorod <br /> sacicn <br /> Holding Temperature_ <br /> Method — gravel w <br /> Screening Method (O/ i _ <br /> Tracking Shcet - (y/ n ) <br /> a.2c2.ft. tt. <br /> SPOILS <br /> Storage Method �'t $4c- MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/&V) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> i Buckets bentonite <br /> Depth to water_ -24'6 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method If l/ Q- o Surge Block: - (y/ n ) <br /> Quantity installed //o Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />