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.. r <br /> MONITORING WEU INS <br /> REPORT . <br /> 3 .? , K, Y CONSTRUCTION <br /> Date•_�._� �� ° � <br /> Total Depth <br /> Premise Address. - ' Screen Length (from) <br /> s Y 'N(to) <br /> Filter Pack .. '(firom) "t :Cto)_ <br /> Well No.: Bentonite '(from) `' <br /> ` Grout - (from) (to) <br /> Inspector: Drilling rig type - <br /> "::` .• * ;Auger O.D. >s. Y.D. <br /> Permit No.' y n i m Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing - <br /> Driller. height t <br /> Consultant <br /> Geologist J1,gO E-WICUND� - C4Fi*TY 30X <br /> r coNPLF-T1ON e - VWPLEnON <br /> G=nd SUiacs <br /> SPECIAL PERMIT INFO. _ <br /> # grout <br /> Distance to sewer line .. <br /> Domestic well on site - (y/ n) �..� !t� <br /> If yes, location and distance.. <br /> P ft <br /> SA NG. - . ` &Odor f <br /> Holding Temperature <br /> Method <br /> Screening Method - - <br /> Tracking Sheet - (y/ ) _ — <br /> SPOILS' <br /> MATERIALS EVEL.OPMENT - .. . <br /> . 'storage Method " <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location gl ft. Screen ft, <br /> Slot size <br /> Bags cement <br /> GROUTING .r �; - Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water - Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of raethod <br /> EH 29 29. <br /> r <br />