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`"'R[iIONITORING WELL INSTALLATION REPM16 <br /> Date: " �� SOU 3 CONSTRUCTION �y <br /> Premise Address: /O Z S ] Total Depth O <br /> Screen Length (from) 74, (to) G <br /> Well No.: <br /> �IItJ/3� Filter Pack (from) (c B (to) S G <br /> �� Bentonite (from) (to) G•� <br /> Inspector: Gk���� L Grout (from) (to) <br /> Drilling rig type <br /> �/ <br /> Permit No. UO.jZ 3 Z / '0°s� �a)323w- !f Auger O.D. /Z' LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant —WVT <br /> Geologist" � � <br /> ABOVE-GROUND C#iAI5TY410X <br /> COMPLETION COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sift + � <br /> Ori <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> = m <br /> _ o <br /> o <br /> SAMPLING slotted = B <br /> sec.on <br /> Holding Temperature prawl pads <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2-,- , <br /> Storage Location Casing type <br /> Blank ' ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water, Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />