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. MONITORING WELL INSTALLATION FORT <br /> Date:_ <br /> l —d 3 CONSTRUCI70N <br /> Premise Address: <br /> SIA.( Total Depth � Q� <br /> Well No.:_ S (� =� a6-54-"e" Screen Length (from)_�_(to) k D <br /> Filter Pack (from) I tc (to)n <br /> Inspector Bentonite (from)_ (, (to) — <br /> � r <br /> Grout (from) fJ (to)�_ <br /> Permit No._ I („ Drilling rig type <br /> Auger O.D. LD. <br /> Drilling Company:_ Completion - Stove pipe/dtrisde box (circle <br /> p <br /> Driller. T,rn y <br /> casing <br /> Consultant g r height <br /> Geologist ��(� [ W' T, <br /> AP,CVE-GROUND <br /> SPECIAL PERMIT INFO. =,FLET1CN C--n*7Y-3CX <br /> �L`TICN <br /> Gr'a:nd Su1xY <br /> Distance to server line <br /> Domestic well on site <br /> Ly <br /> 1� es, location and ance - <br /> SA.MPLING _ c <br /> �lotnd = c <br /> Holding Temperature r, r a sac cn _ B <br /> Method_ L _ <br /> Screening Method <br /> Tracking Sheet . y n ) <br /> SPOILS 12. <br /> yI t <br /> Storage Method -« <br /> Contamination Notedl- C Yi n) MATERIALS/DEVE[OPMENT <br /> Storage Location (' // L� /" <br /> Casing type � - b ��� 57�1ln 1l2v5,� <br /> Blank Zb fr. Screen Zp ft. <br /> GRA Slot size_o to -1 tQ " <br /> Bags cement <br /> Depth to water —./30 t Buckets bcntonite_� <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed I Surge Block: - (y <br /> Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />