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' r <br /> MONITORING WELL IN <br /> REPO T <br /> CONSTRUCTION <br /> Date. <br /> Total Depth <br /> Premise Address: Sween Length <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from)Grout (from) <br /> Inspector. '�' ' ..Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company ti- •� casing <br /> height <br /> Driller: ,� .y <br /> Consultant <br /> Geologist tOIPLETfON C.0wPj-=MCN <br /> Ground Sutxt <br /> SPECIAL PERMIT INFO. gf0vt <br /> Distance to sewer line ft. <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> �• O <br /> Ji <br /> SAMPLING socicn <br /> .,• vv1 pack <br /> Holding Temperature, <br /> Method <br /> Screening MethodA _ <br /> Tracking Sheet - (y/ n) = n• <br /> _tt. _--- ' <br /> SPOILS <br /> — M_ A•T•g�pyS/DEVELOPMENT <br /> Storage Method l0 —,I/C� <br /> Contamination Noted - (y/ n) Casing type , •p f <br /> Storage Location Bl / Q► l fc. Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water Filter Pack type/size <br /> Mix Rados Surge Block: <br /> iristalladon Method Discussed vrith geologist: - (y/ n) <br /> Quantity installed Type of method <br /> EH 29 29 <br />