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i <br /> "'�TITORING WELL INSTALLATION 1. .ORT 1 <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to) <br /> Premise Address: Screen Length (from) (to) <br /> Filte=Pack CfrOm) (to)_--- <br /> Well No.: Bentonite' (from) <br /> Grout (from) (to)__ <br /> Insp ector: Drilling rig typ e <br /> • Auger O.D. I.D. <br /> christie box (circle one) <br /> Permit No. Completion- Stove pipe/ <br /> Drilling Company: <br /> casing <br /> Domer: height <br /> a <br /> Consultant <br /> Geologist �.801/E-GROl1ND C}iRls71'-BaX <br /> tN.�Lt-T}ON COMPLETION `s <br /> Graurd Sur=s <br /> SPECIAL PERMIT MO. i <br /> grcxA <br /> Distance to sewer line <br /> If yes, location and distance- tt �_ - — <br /> • -_-.,,mss-�._.m . <br /> _ O <br /> 2 <br /> SA N1Pi acycn <br /> Holding Temperature <br /> Method <br /> Screening Method - <br /> Tracking Sheet CY/ p <br /> SP OILS <br /> • MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type <br /> Storage Location Blank {t Screen ft• <br /> Slot size <br /> GR= Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Packtype/size <br /> Mix Ratios _ _S.11rge_B_lock:_(.y_/_n_) <br /> Installation Method Discussed with geologist: - (y/ n <br /> Quantity Installed Type of method <br /> EH 29 29 - <br />