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40NITORING WELL INSTALLATION REF T <br /> Date:, <br /> CONSTR <br /> Premise Address: Total Depth <br /> Screen Len ) <br /> Well No.: NL"� 'd ri— w P�r� Filter Pack (from) (t <br /> o) <br /> ( tet, Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> — <br /> Drilling rig type <br /> Permit No. _ Auger O.D. I.D. <br /> Drilling Company:�A,� Completion - Stove pipe/christie box (circle one) <br /> _ ,.........._ <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist r` <br /> ��BO -GROUND <br /> AE;; <br /> CFiRfSTY-8aX <br /> SPECIAL PERMIT INFO. CWPt_ET1CN <br /> 'Qrvund Surfx» ... <br /> Distance to sewer line i grout <br /> Domestic well on site - ( y/ n ) uJ 1 <br /> If yes, location and distance - 3� ------ <br /> SAMPLING _ <br /> slatted = .� <br /> svcton <br /> Holding Temperature <br /> Method gr]Lw Pack <br /> — <br /> Screening Method <br /> Tracking Sheet - (y/ n } — <br /> ti. <br /> SPOILS tit (j <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - { y/ n ) )'t'- <br /> �- <br /> Storage Location Casing typed t'-V! <br /> BIank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ' Ba s sand/ vel <br /> Mix Ratios g <br /> 1���r--� /'<'�'��`.��' `` Filter Pack type/size <br /> Installation Method Surge Block. - { y/ n } <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />