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vIONITORING WELL INSTALLATION REK)"o? <br /> 1 <br /> Date: I ! CONSTRUCTION <br /> 2 <br /> Premise Address: Soo Total Depth <br /> za J Screen Length (from) -Z5;/-7 (to) S Y� <br /> Well No.: Filter Pack (from) — ZS% (to) i-*'17?_-5 <br /> Bentonite (from) -# , -G(to) — `! <br /> Inspector: M Grout (from) — Li !Ls= (to) o <br /> GMC Drilling rig type M E_ -3- <br /> Permit No. D r e vvry�d Auger O.D. g " I.D. Co ` <br /> ��d Completion - Stove pipe/christie box (circle one) <br /> �{ <br />' Consultant ►tely � �pn�' <br /> Geologist U� 1�� � � ak*-Up <br /> T <br /> SPECIAL PERMIT INFO. " <br /> ABOVE-GROUND �1STY-BOX <br /> Distance to sewer Iine f7� StiIP,c - CDA�PLETlON COMPLETION <br /> W <br /> Domestic well on site - ( y/ n Ground Sumacs <br /> If yes, location and distance - groul <br /> ' ft. <br /> SAMPLING = A <br /> Holding Temperature �� do6d ' <br /> Method 12C C On <br /> ScreeningMethod__ � ,+KlR�lrtD✓('"5pack <br /> Tracking Sheet n) <br /> mit. Y` tt. <br /> SPOILS 2-7 <br /> Storage Method �_ _ MATERIALS/DEVELOPMENT <br /> Contamination Notes - ( y <br /> Storage Location___8yi g144, Casing type U G <br /> Blank Z-0 ft. Screen ft. <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel 4-0-; _ Utx_ <br /> Depth to water Filter Pack type/size_'_,,. <br /> Mix Ratios Surge Block: - (y,(Ip <br /> Installation Method _ Discussed with geologist: - y n ) <br /> Quantity Installed _ Type of method <br />