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F <br /> • MONITORING WELL INSTALLATION POORT <br /> Date: Y�� CONSTRUCTION <br /> Premise Address: 5• Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 2 ZZ Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)-(to)- <br /> Inspector: <br /> from) (to)Inspector. e� l Grout (from) (to) <br /> .Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company <br /> Driller: casing <br /> � height <br /> Consultant �C 7 � <br /> Geologist <br /> ABOVE-GRCUND ChRSTY30X <br /> COkPLMON CC%YP TTCN <br /> SPECIAL PERMIT INFO. Suiacr <br /> Distance to sewer line araII <br /> Domestic well on site - (y/ n) It, <br /> If yes, location and distance - — n, <br /> h. <br /> 2, <br /> SAMPLING <br /> ��//�� <br /> CJS secicn <br /> Holding Temperature Al <br /> Method sny �p t <br /> Screening Method RID <br /> Tracking Sheet - (y/ n ) <br /> tt. = ft. <br /> SPOILS p <br /> Storage Method MATERIALS/D <br /> E <br /> /VELOPMENT <br /> Contamination Noted - (y/ Casing type O 9w <br /> Storage Location Blank V ft. Screen fr <br /> Slot size O OzZ o <br /> GROIPCING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel � -- <br /> Mix Ratios Filter Pack type/size <br /> dttstallation Method Surge Block: - (y/n ) <br /> Quantity installed Discussed vrith geologist. - / n ) <br /> Type of method VV <br /> EH 29 29. . <br />