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MONITORING WELL INSTALLATION REI--e-r <br /> Date: <br /> 'V 0y �2 ZOOZ CONSTRUCTION <br /> C <br /> Premise Address: 303 / �� r Tome Depth <br /> Seen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well Bentonite (from) (Lo) <br /> Grout (from) (to) <br /> tnspector. Drilling rig type <br /> Auger OD. box <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � I � vt <br /> -moo �� cas iag <br /> Driller. height <br /> 7 T <br /> Consultant <br /> Geologist l AEC _-GRCUND CHMS1 Y-acX <br /> frS?:_R SON COMPq�i,CN <br /> Ground S+sfaea --� <br /> SPECIAL PERMIT INFO- , <br /> gout <br /> Distance to sewer line �- <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - _-�- <br /> e <br /> a <br /> t10Rad �" `a <br /> SAMPLING ween <br /> Holding Temperature — P <br /> acX <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n) Y _ M <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted (y/ n ) Casing ripe <br /> Storage Location Blank ft- Screen ft. <br /> size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack rype/size <br /> Mix Ratios Surge Block. - C y/ n ) <br /> Installation Method Discussed with geologist: - (Y <br /> Quantity Installed Type of method <br /> EH 29 29 r^� <br />