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t � <br /> MONITORING WELL INSTALLATION FORT <br /> •, CONSTRUCTION <br /> Date: <br /> L S, Total Depth <br /> Premise Address: 3 Screen Length (from) <br /> y �Ll Filter Pack (from) (to)-----�—" <br /> Well No.: �� Bentonite (from) (to) - <br /> !� Grout (from) (to)_ <br /> Inspector: � Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/chrisme box (circle one) <br /> Drilling Company: <br /> F . <br /> casing <br /> Driller: height <br /> IV <br /> Consultant <br /> Geologist ABOVE-GRCUND q-sZTY-DOX <br /> CAl LEMON COMPLEriCN <br /> Cirwrd Surface <br /> SPECIAL PERMIT INFO. <br /> �rcest <br /> Distance to sewer line _ <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> SAMPLING siorsi c <br /> soden <br /> Holding Temperature : : VavoFack <br /> -i <br /> Method - <br /> Screening Method . — <br /> G. <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPIbIENT <br /> Contamination Noted - {y/n} Casing type <br /> Storage Location Blank ft. Screen �• <br /> Slot size <br /> GROUTENG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: • (y/ n ) <br /> Type of method <br /> EH 29 29 <br />