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•MONITORING WELL INSTALLATION RE1&T <br /> Date: 31281 b(-, CONSTRUCTION <br /> Premise Address:} {mac alD ( Total Depth <br /> Screen Length (frpipe/chr�istie <br /> (to) <br /> Well No.: N�Q Filter Pack (fro (to) <br /> Bentonite (fr (to) <br /> Inspecto nc aC� Grout (fro (to) <br /> Drilling rig type <br /> Permit No. Auger O.D.Completion - Stov (circle one) <br /> Drilling Company: W <br /> Driller: basing <br /> y� <br /> Consultant height <br /> a. t 1, S�S�a T <br /> Geologist fo-' — T <br /> ABOVE-GROUND CNAISTY-BOX <br /> COh�LETION CCMPLETION <br /> SPECIAL PERMIT INFO. Orcurd sulwo <br /> Distance to sewer line foul <br /> Domestic well on site - ( y/ n) 1 n <br /> If yes, location and distance - <br /> n. <br /> _n. <br /> - m <br /> e <br /> SAMPLING sbned <br /> sarJan K. <br /> Holding Temperature P <br /> ack <br /> Method d A&A� 1• , _ <br /> Screening Method -_ <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS 5 p 3 <br /> Storage Method MATERIALS/DEVELO NT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> slot size <br /> GROUTING Bags cementvel Buckets be <br /> Depth to water �d t Bags sand/Mix Ratios Filter PackInstallation Method Surge Block. - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />