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v <br /> MONITORING WELL INSTALLATION REPOm <br /> Date: A15 !�`` 7'',,//, / CONSTRUCTION ` <br /> Premise Address: yy Total Depth l S <br /> ,,'',,'' 11 22 Screen Length (from) (to) 35 <br /> Well No.: � /�/J Filter Pack (from)�S 7—(to) 3 3 <br /> Bentonite (from) (to) 30 <br /> Inspector: Grout (from) 0 (to) o <br /> Drilling rig type L Z-" <br /> G! <br /> Permit No. Auger O.D. I.D. f <br /> Completion - Stove pipe/christie b t (circle one) <br /> Drilling Company: <br /> Driller: v2� t f casing <br /> height <br /> Consultant31 <br /> Geologist i <br /> I <br /> h - <br /> OVE•GRCUND A�LEf ION ISTY-BOX <br /> L.E71ON <br /> AB <br /> SPECIAL PERMIT INFO. Ground Saixw <br /> Distance to sewer line grout <br /> Domestic well on site - ( yn p ft. <br /> If yes, location and distance - q� <br /> 1.Lft. tt. <br /> SAMPLING slottrd = <br /> wcaon <br /> Holding Temp re l <br /> Method /' _ Pack <br /> Screening Method ✓ — <br /> r, _ <br /> Tracking Sheet ( y n ) . <br /> w 6Z <br /> SPOILS <br /> Storage Method /JL/`�,;�4r-e-s '�" MATERIALS/DEVELOPMENT <br /> Contamination Noted - n /J�,p (� / <br /> Storage Location .� Casing type /" C '� <br /> Blaftk_ ft. Screen 1u ft. <br /> Slot size D?dJ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth.to water % �.) Bags sand/gravel 7 <br /> Mix Ratios. Filter P2rck type t e 3 <br /> Installation Method " 4 �` Surge BiTck: - (y n) <br /> Quantity Installed Q t Discussed wipFt olo s[: - y. n ) /Q/f•+ <br /> EH 2929 tY .` <br /> Type of method <br /> Atij <br /> a <br /> Z . <br />