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SON MONITORING WELL INSTALLATIOr,,'�PORT <br /> Date: rJ CONSTRUCTION <br /> Premise Address: Is ' Total Depth <br /> Well No.: M � i f Screen Length (from) (to)_ <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (fro ) (to) <br /> Drilling rig type <br /> Permit No. <br /> Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company- <br /> Driller_.bCROJ�i{� ._ casfng <br /> height <br /> Consultant <br /> Geologist T <br /> ABOVE-GROUND CtiRIS[Y-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface camnmoN <br /> Distance to sewer line gra <br /> Domestic well on site - (y/ n) �b <br /> If yes, location and distance - / .f3 C� fL� <br /> ft. <br /> SAMPLING <br /> slottad <br /> saaion ?'i —_ <br /> Holding Temperature <br /> ack <br /> Method M �"�P <br /> Screening Method ' <br /> Tracking Sheet ( y/n) `^ _ <br /> . fL `= ft. <br /> SPOILS <br /> Storage Method MATERIAL&PEVELOPMENT <br /> Contamination Noted - (y/n } PV <br /> uStorage Location Casing tyag— <br /> Blank <br /> Screen_ ft. <br /> Slot size - 02-,D <br /> GROUTING Bags cement CD <br /> O�-I Buckets bentonite <br /> Depth to water b Bags sand/7e/� <br /> Mix Ratios Filter Pack sian <br /> Installation Metho Surge Block: - (yQuantity Installed Discussed with ge - y ( n ) <br /> Type of method <br /> EH 29 29 <br />