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MONITORING WELL INSTALLATION RL 'P-rtr <br /> Date: '" v 6 CONS7,tU=ON <br /> 3 C Q� Total Depth <br /> ?remise Address:t ( I Screen Length (from) (to) <br /> Well No.: L " " ' c F1ter Pack (from) (to) <br /> Bentonite (from) (to) <br /> h Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> ?ermit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. <br /> Consultant T w\ <br /> Geologist ,QVC--G 1ND C {5�WX <br /> 0CW =1 ZN C;M{p(=i,CN <br /> Ground Suis <br /> SPECIAL_ PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site ( y/ n ) l ♦ �' <br /> If,yes, location and distance - ` t- <br /> _I a <br /> SAMPLING dacsnd _ a <br /> Holding Temperature <br /> -Method ,A, <br /> Screening -Method V" <br /> Tracking Sheet ( y/ n ) <br /> SPOILS <br /> s I NWT'-PIUAL.S/DEVELOPN ENC <br /> Storage -Method <br /> Contamination Noted - (y/ n ) �P Casing type <br /> Storage Location Blank ft. Screen Et <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Filter Pack typesize <br /> Mix Ratios Surge Block- - (y/ n ) <br /> Installation -Method Discussed with geologist: - ( y/ a) <br /> Quantity Installed Type of method <br /> EH 29 29 <br /> C�. <br />