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s r-wMONITORING WELL�REFycT <br /> Date:4j/'2YD CONSTRUC'T'ION <br /> Premise Address: R&O Ut- 4e-'j Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Inspector: 14-Ki4 <br /> p Bentonite (from) (to) <br /> Q ( Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant <br /> ceelegisr <br /> ABOVEGROUND <br /> OONFLETION CHRISTY-BOX <br /> SPECIAL PERMIT INFO. Groundgurfxy COMPLETION <br /> Distance to sewer line pram <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft• <br /> ft. <br /> n. <br /> = m <br /> = m <br /> SAMPLING <br /> 0 <br /> slotted = S <br /> socton <br /> Holding Temperature = P <br /> Methodgmvel <br /> Screening Method —_ <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />