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MONITORING WELL, INSTALLATION AT <br /> Date: f���7/ CONSTRUCTION <br /> Premise Address: If ( Total [h _ <br /> Well No.: PT . T —d Screen Le (from) (to) <br /> Filter Pack (from) (to) <br /> Inspector: _�w�.�•C, Bentonite (to) <br /> y� Grout ( (to) <br /> Permit No, yu°00G gfc' 2,0 Drilling rig type <br /> t )AE�;V�E-GRCUND <br /> ger O.D. I.D. <br /> Drilling Company:. G C� mpletion - Stove pipe/christie box (circle one) <br /> Driller:_ t C R <br /> casing <br /> Consultant_ n�nQ� <br /> eight <br /> Geologist l"'"�-' T <br /> MPLETION Cf1R M-aaX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Stalxe <br /> Distance to sewer line gran <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft <br /> ft ft. <br /> = m <br /> SAMPLING o <br /> Holding mperature t — <br /> Method /Wr _ Vol pack <br /> Screening Method <br /> Tracking Sheet - (y/ ri <br /> SPOILS <br /> Storage Method l� S MATERIALS/DEVELOPMENT <br /> S/DEVELOPMENT <br /> Contamination Noted - (yon ) <br /> Storage Location ��// Casing type \ <br /> Blank h. Green ft, <br /> Slot size <br /> GROUTING ;� Bags cement <br /> Depth to water 0� l & Buckets bentonite <br /> Bags sand/gravel <br /> M x Ratios Filter Pack type/ ' e <br /> Installation Method Surge Block: y/ n ) <br /> Quantity Installed <br /> Discussed geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />