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MONITORING WELL INSTALLATION <br /> RENT <br /> Date•_ �1 ���b �r ._ CON _ <br /> STRUCTION <br /> Premise Address:_Z Total Depth <br /> Well No.: Screen Length (from) (to)— <br /> Filtei'Pack (from) (to)— <br /> Inspector: Df "^�-P Bentonite (from (to)________ <br /> Grout (fro (to)___ <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. <br /> i <br /> Completion - Stov pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> COMRLEMN CHRMW-SOX <br /> SPECIAL.PERMIT INFO Ground SCOMPLETION <br /> - uiiac.� �.�.�,..�.. <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> SAMPLING <br /> sbttad y "— � <br /> soclon <br /> Holding Temperature <br /> Method = vivo,Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen,.-_& <br /> Slot size <br /> GROUTING Bags cement <br /> S-,1,60► i S Buckets ben Depth to water V Bags sandlgrav <br /> Mix Ratios Filter Pack tyr /size <br /> Installation Method Surge Block: (y/n) <br /> Quantity Installed Discussed geologist: - (y/ n) <br /> Type of me od <br /> EH 29 29 <br />