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MONITORING WELL INSTALLATION REPDXff <br /> Date: 6 CONSTRUCTION <br /> Premise Address: Vag N' r Total Depth 7 <br /> �11W_ Screen Length (from) (to) #)A'Well No.: Filter Pack (from) (to) fL <br /> Bentonite (from) /2, (to) <br /> Inspector. bd'L�.►�.�-[.' Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company; <br /> Driller: iJ casing <br /> height <br /> Consultant„_(�/l�t! _� IV � <br /> Geologist �,�„ , -- T <br /> ABOVE-GRCUND I cI-wLsti-v-aa <br /> � �raM j COMPLETIC <br /> SPECIAL PERMIT INFO, Ground 5 <br /> Distance to sewer line <br /> Zd, grout <br /> Domestic well on site - {y/ n) �. <br /> If yes, Iocation and distance - L <br /> ft. 7 E'_�. <br /> 'Nr - <br /> V, O <br /> SAMPLING glomi — <br /> nG secicn _ <br /> Holding Temperature : QM W pack <br /> Method <br /> Screening Method -Z _ <br /> Tracking Sheet - (y/ n ) - <br /> '.X <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type V <br /> Blank__L, ft. Screen'td ft, <br /> Slot size <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 BIoek: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />