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MONITORING WELL INSTALLATION R H--e-T~ <br /> Date: J CONSTRUCTION <br /> 3 �-J�� Total Depth <br /> Premise Address:,, Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Inspector. n� � Grout (from) (to) <br /> Drilling rig type <br /> Auger O.D. I.O. <br /> Permit No. Completion -Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> ' casing <br /> Driller. —:F height <br /> Consultantr,L2d <br /> Geologist �\ <br /> IIBCYE-t;�tCUNO d-AIS^!-30X <br /> CCk !r1ON COMPL_i,CN <br /> SPECIAL PERMIT INFO. G=nd Siztacs <br /> e <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) NX, --`�- <br /> If yes, location and distance - `!- <br /> ft. 16---- <br /> a <br /> O <br /> SAMPLING :bcu+d a <br /> axticn '— � <br /> Holding Temperature Li MethodScreening MethodTracking Sheet - (y/ nT n- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPN ENT <br /> Contamination Noted - (y/ a) <br /> Storage Location Casing type -- <br /> Blank ft. Screen (- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Ratios Filter Pack type/siz <br /> Mix Ra <br /> e <br /> Mix R tiontion Method Surge Block. - (y/ nInst ) <br /> Quantity Installed Discussed with geologist: - C y/ a) <br /> Type of method <br /> EH 29 29 <br />