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SMON'ITORING WELL INSTALLATION REF& <br /> Date: I, �OL- CONSTRUCTION <br /> Premise Address: j(' ,, An . Total Depth_ -5 <br /> Screen Length (from) �b ([o) <br /> Well No.: —(o Filter Pack (from)_ (to) <br /> Bentonite (from) t G ` (to) <br /> Inspector. ��.c fir Grout (from)_ 9 (to) !! <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: � � 11� <br /> Completion -Stove pipe/duistie box (circle L,1Q.� <br /> Driller.__ casing <br /> Consultant �t-�pR �n � height <br /> Geologist ��i Anti( , <br /> ABCVE{;ACUND <br /> CC&PLETION CtSM Y-doX <br /> SPECIAL PERMIT INFO COWPtEnCN <br /> (around Stzlacs <br /> Distance to sewer line prcut <br /> Domestic well on site - ( n ) <br /> If yes, location and d's ante - ft. <br /> _ <br /> SAMPLING = <br /> slow <br /> secicn <br /> Holding Temperature = <br /> Method = cravntPack <br /> Screen in;Method + _ <br /> Tracking Sheet - (y/ n ) <br /> 3 -3' fi. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type_ 41` S54z� ML.» Sl,.o! -k PVA <br /> Blank S_ft Screen 2-0 eft. <br /> GROUTING Slot size a 2r, <br /> Bags cement <br /> Buckets bentonite <br /> Depth 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 /> EH 29 29 Type of method <br />