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MONITORING WELL INSTALLATION PJU--tT <br /> S 1ss� 2960 <br /> Date: `2 CONSTRUCTION J <br /> Premise Address: r Total Depth v <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. �Zi � 7 Grour (from) (to) <br /> -Drilling rig type <br /> Permit No. � �F Auger O.D. I.D. <br /> Completion - Stove pipe/caristie box (circle one) <br /> Dulling Company-. e �- � ��iTV� <br /> Driller. casing <br /> V� t .� height <br /> Consultant <br /> in <br /> Geologist ABCVEvatXND \� <br /> Cvf.QLTICN d-RISTY-oOX <br /> CQMP'�i iCN <br /> SPECIAL PERMIT INFO. G=nd SLrf'" "�- <br /> r ' <br /> gra.K <br /> Distance to sewer tine <br /> Domestic well on site - ( y/ a ) ft- <br /> If,yes, location and distance - <br /> s <br /> 0 <br /> SAMPLING abrsd = = a <br /> Holding Temperature _ _ kava adc <br /> Method <br /> Screening Method <br /> Tracking Sheet • ( y/ n ) <br /> ;L _� t tL <br /> SPOILS <br /> Storage Method MATERIAIS/DEVELOP''v1FNT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft- Screen 1r- <br /> Si0[ size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depthater Bags sand/gravel <br /> Mix Ratios Fater Pack type/size <br /> Installation Method Surge Block: - ( y/ n } <br /> Quantity Installed Discussed with geologist - ( y/ a ) <br /> ^ � Type of method <br /> F d <br /> 7C <br /> �e�7s1 Gr� <br />