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MONITORING WELL INSTALLATION R U—Itr <br /> Date: l��/ Z �� CONSTRUCTION <br /> Premise Address: Total Depth <br /> Steen Length (from) (to) <br /> Well No.: w / Z '•�� Filter Pack (from) (to) <br /> ,' ea Benronite (from) (to) <br /> Inspector. Grour (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casi-ag <br /> height <br /> Consultant I'a —WILT! ✓'tom <br /> Geologist ` Q$Sh� <br /> ABGVEv'ACUNO q.A�-eiOX <br /> CCMP'ETiCN C MPI E7, CN <br /> SPECIAL PERMIT INFO. Cf nd Sidi —Z� <br /> r <br /> nout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) t- <br /> If yes, location and distance - L <br /> 73 <br /> 0 <br /> SAMPLING abaaa Z = a <br /> Holding Temperature _ _ 71 Vi;acK <br /> Method <br /> Screening Method <br /> Tracking Sheer - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEyELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fr- Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �Z Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Merhod Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist - (y <br /> Type of method <br /> EH 29 29 <br />