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MONITGNM WELL INSTALLATION RE :T <br /> Date: S�I`�r n/ie CONSTRUCTION <br /> Premise Address: Total Depth Io0' tvJ{S <br /> Well No.: <br /> PT SEV-1 _ 19T Screen Length (from) (to) <br /> y Filter Pack (from) (to) <br /> Inspector. �1t4l ) Bentonite (from) (to) <br /> Grout (ft oRt)�(to) <br /> Drilling rig type_!!``+ <br /> Permit No. Auger O.D. t i-` I.D.K <br /> Drilling Company:_]/ <br /> /a Completion - Stove pipe/cluistie box (circle one) <br /> w <br /> Driller ��� casing <br /> /I height <br /> Consultant_�7. '/ <br /> Geologist _ <br /> ABOVE-GACUND <br /> CONFLETION (iCHRMiNBOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> GroundSaian <br /> Distance to sewer line SVF I SdC L orou< <br /> Domestic well on site - (y/ n ) L <br /> If yes, location and distance - '� 1� ft. <br /> V <br /> Sws�.ln•Z.J — <br /> So, <br /> SAMPLING So, 'LA n&�k &-d-UrS doter! <br /> (I soden <br /> Holding Temperature q°L <br /> Method30 _ Rawl pad[ <br /> Screening Method t� i _ <br /> Tracking Sheet / n ) ; <br /> SPOILS r ; <br /> Storage Method .0 elv[�e� _ MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location n .L Casing e { UCS <br /> Blank I0 ' ft. Scremlo 'to-loft. <br /> GROUTING Slot sizetl.0 20 <br /> IIags cement <br /> i Buckets bentonite <br /> Depth water ~�0 s sand/gravel <br /> Mix Ratti Bags <br /> g _ 3 <br /> _ Filter Pack type <br /> /siz <br /> Installation Method a It -z Surge Block: • (y n <br /> Quantity Installed l t/v S Discussed with geo gist•. - (�/ n ) <br /> EH 29 29 Type of method <br />