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!I <br /> �NITORJNG,WELL INSTALLATION 1tJF <br /> k O <br /> )' <br /> Date: 4.4 . c14 j p <br /> CONSTRUCTION <br /> Premise Address: tOD <br /> Total Depth 2 <br /> Well No.: VIA I I Screen Length (from) 2 (to) _ <br /> Filters Pack .F (from) <br /> Inspector. Bentonite (from) 2© (to) z <br /> Grout (from (to) � <br /> Permit No. Drilling rig type <br /> Auger O.D. ', I.D. <br /> Completion;- Stove pipe/christie box (circle one) <br /> Drilling Company: ! <br /> i <br /> I <br /> Driller: 'iv. <br /> caging <br /> Consultant height <br /> GeoIo&t AWYE-G�+/.QW'� �► <br /> SPECIAL PERMIT INFO. G=nd Swfact . i <br /> Distance to sewer line ! 4 9rcut <br /> Domestic well on site - n} <br /> If yes, loc o and distance - } <br /> SAMPLING sloredc <br /> j <br /> so cn <br /> x•: <br /> Holding Temperature "" <br /> Method �(0_ a.• v. KP <br /> 1. <br /> Screening Method IPLD _ <br /> Tracking Sheet - (y/ n } :.; <br /> SPOILS '! 1 0L <br /> ��IIytS �(� t <br /> Storage Method , E. MATE UALS/DEWI.OPMENT <br /> Contamination Noted - �� <br /> Storage Location.- `'/ �r1_ - ._ Casing type .i `i u <br /> Blank'I /-Z. ft. Screen ft. ; <br /> Slot size j %02-'C> <br /> GROUTING Bags cement;1 +' <br /> 31, <br /> Buckets bentonite C-K2 5 '� <br /> Depth to water ` Bags sand/gravel 19,75 <br /> Mix Ratios r)"4mvy Py - 3D442 ffzv Filter Pack type/size _ fir' <br /> Installation Method fir, h a e,5 Surge Block: `- ( y/ n <br /> Quantity Installed Discussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 <br /> j t <br /> t f( <br /> '� + <br />