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MONITORING WELL INSTALLATION IiEP"T <br /> Date: Jf l ! CONSTRUCTION <br /> Premise Address: Total Depth <br /> l,, r Screen Length (from) 's�7 (to) 3n <br /> Well No.:, yU Filter Pack (from) (to) z9 <br /> Bentonite (from) 2 (to)? <br /> Inspector: VV l v Grout (from) (to) <br /> Drilling rig type A4 n 1Z /L- <br /> Permit No.T D �' � Auger O.D. 2%{-" I.D. " <br /> W <br /> A ti Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: VV <br /> Driller: ,f'+- Iv h- i.t fl casing } <br /> _ <br /> 17T height <br /> Consultant �V�1 S <br /> inr <br /> Geologist _S66— •- <br /> ABOVE-GROUND C7�itSTY-SOX / <br /> COhfPl.ETION COMPL,ETION_� <br /> SPECIAL PERMIT INFO. Ground Surfaa• <br /> Distance to sewer line / , f grout <br /> Domestic well on site - (y/0 5 <br /> If yes, location and distance - ZJ <br /> tt. <br /> SAMPLING slotted w — c <br /> ##+,03 asc'�ian <br /> Holding Temperature gravw P <br /> Method 'b P.A Z(L U� S e 0.nk � _ <br /> ack <br /> Screening Method 44 <br /> Tracking Sheet y n) <br /> SO y <br /> SPOILS <br /> Storage Method r s N MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n y TV <br /> Storage Location Casing type <br /> Blank aO ft. Screen zo ft. <br /> Slot size OZ-0 <br /> GROUTING CSf � Bags cement i <br /> // f f Buckets bentonite <br /> Depth to water Ll ' �r "( �� �l ) Bags sand/gravel <br /> Mix Ratios 4 Filter Pack typ ize _ <br /> Installation Method Surge Block: it y/n ) <br /> Quantity Installed Discussed with-geologist: - (� / n ) <br /> Type of method <br /> EH 29 29 <br />