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*ONITORING WELL INSTALLATION RE* .. <br /> Date:_ <br /> �� CONSTRUCTION <br /> Premise Address: 02� S• ���� C�.�X. Total Depth <br /> Well No.: &.Qt Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) <br /> (to) <br /> Permit No.�������, S �j'd6�'� Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company Oj}GQ yJ Completion - Stove pipe/clzristie box (circle one) <br /> Driller: V&AA � <br /> casing <br /> Consultant !AJ � <br /> height <br /> Geologist U�t� �2/(0 6714Y33 <br /> ABOVE-GACUND <br /> COMPLEMN CNAtS?Y-8OX <br /> SPECIAL PERMIT INFO COMPLEMON <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) l <br /> If yes, location and distance - L_ft. <br /> �.._.ft. ft. <br /> SAMPLING Al A, <br /> Holding Temperature <br /> aecicn -- <br /> Method = g,V'W Pack <br /> Screening Method s <br /> Tracking Sheet - (y/ n ) .r _ <br /> ft. <br /> SPOILS ^ -Q <br /> Storage Method 64M S MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ ) L <br /> Storage Locations T <br /> Casing type a q <br /> Blank ft. een ft <br /> GROUTING Slot size <br /> Bags cement <br /> ' Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method v�(� w Surge Block: - (y <br /> Quantity Installed VeUt;ee1 Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of metliod <br />