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MONITORING WELL INSTALLATION Ri,-_JRT <br /> Date: e <br /> 3 'SIHLy CONSTRUCTION <br /> Premise Address: ho S 4.�( Total Depth <br /> Well No.: V <br /> W �, 6 .1 Screen Length (from) (to) <br /> 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 /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: _ casing <br /> .% height <br /> Consul tan[_ <br /> Geologist <br /> A OVE-GacuND <br /> COM PLETCN C7-01STYW <br /> COMPLET N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line 6v _ Grp <br /> Domestic well on site - ( y ) <br /> If yes, location and distance - tt• <br /> S o tt <br /> ^0v = <br /> = L <br /> SAMPLING h = <br /> V •to rted —_ � <br /> � sac�en <br /> Holding Temperature v = <br /> Method -----_ = a""'W Pack <br /> Screening Method <br /> Tracking Sheet ( y/ n ) _ <br /> ft. — ft. i <br /> SPOILS V6- r , �� ��, A <br /> Storage Method X"-CZJ MATE RIALS/DEVELOPMENT <br /> Contamination Noted g typ ��ln�/ , <br /> Storage Location 01ti� Casin a <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 3�0 rid Bags sand/gravel _ <br /> Mix Ratios-044 ter' Filter Pack type/size <br /> Installation Method ,,./Q Surge Block: - ( y/ n <br /> Quantity Installed yk"�'h Discussed with geol st: n ) <br /> EH 29 29 <br /> Type of method <br /> - <br />