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TiONITORING WELL INSTALLATION REPOT,i <br /> Date: �'7' O� Vt�+.o> CONSTRUCTION <br /> Premise Address: D+A't. Z,701 P-Uj'('*� Total Depth <br /> /lJ D <br /> ScreeLength (from C) <br /> D (to) _ <br /> Well No.: Filter Pack (from) 610 (to) 39 <br /> Bentonite (from) 38' (to) 33 <br /> Inspector: Grout (from) 33 -(to)�— <br /> �/ / Dulling rig type {cI <br /> Permit NO. (O Aug.�r 1. I.D. 4 <br /> �+ Completion - Stove pipe/chris e box (circle one) <br /> Drilling Company: zsi <br /> Driller: casing <br /> height <br /> Consultant / "C!lt� <br /> Geologist <br /> ABOVE-GROUND <br /> CO FLETION CHRfSTY4= <br /> PLEflO <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Grp <br /> Domestic well on site - ( y n >t <br /> If yes, location and distance <br /> �S <br /> f� A <br /> SAMPLING <br /> I 4/• C <br /> slotted <br /> Holding Temperature <br /> Method _ gi W pack <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) / <br /> `o <br /> SPOILS q. <br /> Storage Method SS 5&. _ , M_ ATEWALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location Casing type 2�t S QV'C- <br /> Blank ft. Screen ZD ft. <br /> Slot size -OLO <br /> GROUTING Bags cement 6 V <br /> t I! Buckets bentonite �. <br /> Depth to water T`P Bags sand/gravel 7 _ <br /> Mix Ratios Filter Pack type/size Z1 1 <br /> Installation Method Surge Block: - <br /> Quantity Installed - Discussed with geologist: - (DIn ) <br /> EH 29 29 Type of method._ ¢( -�n lD ��a►- <br /> 3 <br /> 3 q4 /DA <br />