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j <br />MONITORING NVELT,,= INSTALLATIONRE;F)nf <br />P <br />Date: <br />CONSTRUCTION <br />"Total Depth <br />Screen. Length (from) 2'c] (to) <br />Filter Pack. (from) (to) <br />Bentonite(from) C/ (to) <br />Grout (from) r i_ (to) 0 <br />Drilling rig type C*V-C <br />Auger O.D. 11 I.D. <br />Completion - Stove piper7christie 66'� (circle one) <br />casing <br />height <br />ABOVE -GROUND <br />OOWLETION <br />G=nd S <br />ii <br />SAMPLING :� <br />i - . '� ��­ � i ­r " - � slotted <br />1! , Ab <br />Holding <br />Screening Method <br />Premise Address: - <br />Tracking Sleet - (g7n <br />Well No. - <br />Inspector: <br />Permit No. .t 6� <br />210a 6 <br />Drilling Comp <br />Driller: <br />Consultant <br />Geologist <br />Contamination Noted - <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />f o <br />well on site - (y <br />Domestic we <D <br />If location and distance - <br />CONSTRUCTION <br />"Total Depth <br />Screen. Length (from) 2'c] (to) <br />Filter Pack. (from) (to) <br />Bentonite(from) C/ (to) <br />Grout (from) r i_ (to) 0 <br />Drilling rig type C*V-C <br />Auger O.D. 11 I.D. <br />Completion - Stove piper7christie 66'� (circle one) <br />casing <br />height <br />ABOVE -GROUND <br />OOWLETION <br />G=nd S <br />ii <br />SAMPLING :� <br />i - . '� ��­ � i ­r " - � slotted <br />1! , Ab <br />Holding <br />Screening Method <br />Tracking Sleet - (g7n <br />SPOILS <br />Storage Method <br />Contamination Noted - <br />y n-) <br />Storage Location- <br />f o <br />GROtMNG1 <br />Depth to w <br />12,ater, <br />Mix Rados li, <br />Installation Method <br />Quantity Installed <br />11`10�001ffm <br />VAV'W Pack <br />—fL <br />MATERIALS/REVELOPWNT <br />Casing _type 2, C <br />Blank ft., ScreenLS <br />- <br />Slot size 'b/'O <br />Bags cement <br />Buckii6 bentonite <br />-Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - C y/ n <br />Discussed with geologist: - y n <br />Type or methodEH 29 29 N IN, V <br />IN, <br />