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TvIONITORING WELL INSTALLATION REPO <br /> Date:_ /d CONSTRUCTION <br /> �j <br /> Premise Address: 0 �d Total Depth �J <br /> Screen Length (from) _ Y (to) <br /> Well No.: Filter Pack (from) (to) <br /> Yz- <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) t 2 <br /> Drilling rig type S <br /> Permit No. to /0 u/ Z Auger O.D. C)- I.D. <br /> Compl Stove pipe/christie box (c' cle one) <br /> Drilling Company: <br /> Driller: t f c ing <br /> the ght <br /> Consultant / T <br /> Geologist <br /> ABOVE-GROUND CNAISTI'-80X <br /> COf iPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfxa <br /> ..i �1 <br /> Distance to sewer-1u�� grout <br /> Domestic well on site - ( y n ) <br /> If yes, location and distance - UIA, ft. <br /> ��• <br /> = m <br /> — e <br /> — m <br /> SAMPLING tlottad = c <br /> suction V. — - � <br /> Holding Temperature = rival pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS /� _J . <br /> Storage Method la'. "" �"`� � MATERIALS/DEVELOPMENT <br /> Contamination No*ted <br /> Storage Location Casing type 1 <br /> Blank ft. Screen ft. <br /> Slot size Ol o <br /> GROUTING Bags cement <br /> Buckets ben17, <br /> tonite t r 7D <br /> Depth to water Bags sand/gravelIf <br /> d <br /> Mix Ratios Filter Pack type/size <br /> Installation Medlod Surge Block: - (y n <br /> Quantity Installed _ AOS_ Discussed with geo gist: - (y(o <br /> Type of method <br /> EH 29 29 <br /> �� a p3 <br />