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*MONITORING WELL INSTALLATION RFIOT <br /> Date: 7 J�"�� CONSTRUCTION <br /> Premise Address:�N Total Depth <br /> Well No.: l��Py�{iay /' 7 Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: JGt` <br /> Completion - Stove pipe/christie box�(circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant_ (�1 ....,P,At ,.e,�s47 <br /> Geologist_y/K <br /> ABOVE-GROUND <br /> COMPLETION CHRISN43OX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> tirvund Stulaca <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - 1 ft. <br /> ft. ft' <br /> — o <br /> = o <br /> SAMPLING — o <br /> slotted — c <br /> V'& sedan <br /> Holding Tempepture 7�L _ <br /> Method �S• PAI ; = Gr+vsl Pxtc <br /> Screening Method <br /> Tracking Sheet - / n ) ' <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <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 />