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,,,.,NITORING WELLIN9==WREpk <br /> Date: f CONSTRUCTION <br /> Premise Address: (/ S �Q � � �� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 14A– Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 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: � casing <br /> height <br /> Consultant�ql ,1 jl !(( 'b <br /> GetsAL'�/ T <br /> ABOVE-G R CUND <br /> COMPLEMCN <br /> CO A�L,�'7f0 N CNAtSrY-30X <br /> SPECIAL PERMIT INFO. Ground Sartacs <br /> Distance to sewer line °foul <br /> Domestic well on site - ( y/ n ) <br /> ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> v' m <br /> �- C <br /> SAMPLING elot'v.� — <br /> 6 soc�cn y <br /> Holding Temper eT <br /> Method �VOZ o <br /> Screening .)vlechod — <br /> Tracking Sheet n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen 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 Block: - ( y/ n ) <br /> uantity Installed Discussed with geologist: ( y/ n ) <br /> Type of method <br /> EH 2 9 <br />