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i%WMONITORING WELL INSTALLATION REI,.ttT <br /> Date: CONSTRUCTION <br /> Premise Address: V -r Total Depth <br /> Screen Length (from) 3 O ,(to) C7 <br /> Well No.: f, l Filter Pack (from) (� (to) <br /> Inspector: W0 N`� GroutBento (from) <br /> (from) (to) <br /> (from) (to) D <br /> Permit No. p ID Drilling rig type !ice <br /> Auger O.D. 3•f 7 _ I.D. <br /> �y Completion - Stove pipe/christie box (circle"one) <br /> Drilling Company: to <br /> o <br /> Driller q _ 1 e cas ing <br /> height <br /> Consultant <br /> Geologist [ ( `c ,f b T <br /> ABOVEGROUND __ <br /> �fl a COMPLI;TiGN COMPt.ETIQN <br /> SPECIAL PERMIT INFO. Ground Surfacy <br /> Distance to sewer line groat <br /> Domestic well on site - (y n- ZZ <br /> If yes, location and distance - r��` &; ► • <br /> 114W ft. <br /> 114 <br /> S � C <br /> SAMPLING 4V_M�� cur Cv slotted = g <br /> e_ <br /> wcton <br /> Holding Temperature Does <br /> C = �f5`9l P <br /> Method ' <br /> Screening Method I <br /> Tracking Sheet - (y/ n ) N <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location �� .S +�-[ Casing type <br /> Bunk _ILft. Screen Z ft. <br /> Slot size <br /> GROUTING 4 Bags cement <br /> N Buckets bentonite <br /> Depth to water r Bags sand/gravel <br /> Mix Ratios �- Filter Packtyp ize <br /> Installation Method' Surge Block: [ /n ) <br /> Quantity Installed Discussed wi eologist: - y n) <br /> Type ;mletho <br /> EH 29 29 , <br /> r <br /> r <br />