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O NITORING WELL INSTALLATION REPO' <br /> Date: �- <br /> CONSTRUCITON <br /> Premise Address: v` Total Depth ! <br /> 3 Screen Length (from) f (to) <br /> Well No.: Filter Pack (from) <br /> Inspector. Bentonite (from)__ <br /> Grout (from) 1 (to)_ 'S D ' <br /> i G��� Drilling rig type <br /> Permit No. l Auger O.D. : LD <br /> Drilling Company: Completion - Stove pipe/christie ox (circle one) <br /> Driller: casing <br /> h / height <br /> Consultant, IA I - - <br /> Geologist <br /> ABOVE-GACUNfl <br /> COMPLETION Zm=�N <br /> i'Y-8 <br /> SPECIAL PERMIT INFO. Ground S,f,� <br /> Distance to sewer line `�V ori <br /> Domestic well on site - y n) <br /> 1c)If yes, location and dist ce - r ft- <br /> �S S �� tL <br /> Y - a <br /> SAMPLING — o <br /> Warted <br /> aoc'icn <br /> Holding Temperature N _ <br /> Method <br /> Screening Method ' L I <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Locations Casing type V C— <br /> Blank. ft. Screen <br /> Slot size d �)--- <br /> GROLITING Bags cement <br /> Buckets bentonite <br /> Depth to water 3 r Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y I n <br /> Quantity Installed Discussed with geologist: - (yI/19 <br /> Type of method <br /> EH 29 29 <br />