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•MONITORING WELL INSTALLATION REOT <br /> Date:�IY� I b 1 CONSTRUCTION <br /> Premise Address: 9jV_-5 1 ,4a• �� �V Total Depth 1 Y'5 <br /> Screen Length (from) 8 (to) S <br /> Well No.:—)S3 b Filter Pack (from) (to) <br /> Bentonite (from) 1. (to) (' . <br /> Inspector. r 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: casing <br /> height <br /> i7ll <br /> Consultant <br /> Geologist V <br /> ABOVE-GACUND <br /> COMPLETION CMMM-BOX <br /> MI <br /> SPECIAL PERT INFO. GroundgurfYy COMPLEnON <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �`ft. <br /> If yes, location and distance - <br /> • ft. <br /> ft. <br /> 0 <br /> p <br /> SAMPLING �Icnai = s <br /> soden '- <br /> Holding Temperature = <br /> Method = a7P°Ipa* <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> < _= . <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) / (/ <br /> Storage Location Casing typer FV(- <br /> Blank fr. Screen fr. <br /> Slot size 0. 0/0 <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 />