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MONITORING WELL INSTF:LLATION REPOnf <br /> r <br /> Date: %' ' Z CONSTRUCTION <br /> Premise Address: <br /> Total Depth ZJ 4 <br /> Screen Length (from) 3• (to) <br /> Well No.: j15 Filter Pack (from) 7,05;6 (to) <br /> ✓ tonite (from) 2,-37 -5 _(to) Z Y <br /> Grout (from) 2-� (to) C>Inspector: ' <br /> ing rig type S�xu Gdi.� <br /> Permit No. <br /> 80���2� Auger O.D. g I.D. (o <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: 7 height <br /> Consultant <br /> GeologistlIB <br /> .� <br /> OVE-GFIOUND RiSTY BOX <br /> CowPLET{ON <br /> SPECIAL PERMIT INFO. Ground StAiscs <br /> ? grout <br /> Distance to sewer line 2,?�2-5 ft <br /> Domestic well on site - n ) <br /> X <br /> If yes, location and distance - U ft. <br /> 3.5 ft. <br /> _ m <br /> n <br /> o <br /> SAMPLING s10 _ c <br /> soc�on — <br /> Holding Temperature V "si pack <br /> Method — <br /> Screening Method <br /> Tracking Sheet n ) Z�g ,C ft• — <br /> SPOILS ZsCO <br /> Storage Method MATERIALS/DEVELOPM <br /> EN <br /> T <br /> Contamination Noted - n ) Casing type <br /> Storage Location 5lt� �Q`�`� Bl �,�j fr• Screen fr <br /> Slot size <br /> GROUTING Bags cement <br /> f Buckets bentonite -30 <br /> Depth to water ` v Bags sand/gravel <br /> Mix Ratios t /S 23 � ��d Filter Pack type/size <br /> ,u� �'' Surge Block: - (yg <br /> Installation Meth n <br /> Quantity Installed /3 -y Vl/'� 337 Discussed with get: - (y <br /> Type of method <br /> EH 29 29 <br /> `�OfY r <br />