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MONITORING WELL INSTALLATION PJEFbrot <br /> za <br /> Date: <br /> CONSTRUCTION <br /> r <br /> Premise Address: 6, 64S Total Depth_ - <br /> `YL - Screen Length [firm) by (to) � <br /> Well No.. Filter Pack (from) (to) Ji2 <br /> Bentonite (from) (to) <br /> Inspector. Grour (from) ie <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Dulling Company: <br /> M Completion-Stove pipe/christie box (circle one) <br /> Driller. Tcazinq <br /> T !height <br /> Consultant V <br /> -�� r 171 <br /> Geologist52 r ( __ ABOYS-GROUND <br /> CC��oN CHRM-Sox <br /> COMPLETnN <br /> SPECIAL PBRM INFO. G`O""d Surf°"' <br /> Distance to sewer line <br /> Domestic well on site - OF—n <br /> If yes, location and distance ' fL <br /> v w <br /> ;r• =3 <br /> a <br /> SAMPLING do6d ;, <br /> Holding Temperature Pack <br /> Method <br /> Screening Method — <br /> Tracking Sheet / n} A <br /> SPOILS <br /> Storage Method MATERIAIS EVELOPMENT <br /> Contamination Noted - a} C <br /> Blank � <br /> Storage Location meV Zd ft. <br /> Blank ��:. <br /> Slot size ' d to <br /> GROUTING Bags cement <br /> r i Buckets bentonite <br /> Depth to water Lit, Bags sand/gravel <br /> Mix Ratios,, Filter Pack typ _ <br /> Installation Method Surge Bloc�alozist: <br /> n) ,� r- <br /> Quantity Installed Discussed - a) <br /> Type of method <br /> EH 29 29 <br /> . 1 <br /> d <br />