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v <br /> MONITORING WELL INSTALLATION REPO <br /> Date: <br /> CONSTRUCTION N-1� <br /> �� d <br /> r''�` � Total Depth <br /> Premise Address: n Screen LenT <br /> (to) <br /> n� Filter Pack (to) <br /> Well No.: o- ` - Bentonite (to) <br /> U Grout (to) <br /> Inspector. Drilling rig <br /> Auger O.D. I.D. <br /> Permit No. Completiochristie box (circle one) <br /> Drilling Company: <br /> qht <br /> Consultant <br /> Geologist ASOVE-GRCUND C1HRZTY.30X <br /> COWFLETCN C*MPLEMON <br /> G=rid Stet <br /> SPECIAL PERMIT INFO. <br /> proof <br /> Distance to sewer line ft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> M <br /> i� ''�Q� tlor'c = c <br /> SAMPLING f���Z U sot'icn <br /> Holding Temperature — <br /> Method <br /> Screenin;Method <br /> Tracking Sheet - (y/ n) _ <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method I <br /> Contamination Noted- (y/n) Casing type �l <br /> Storage Location Blankft. Screen_.______ fr• <br /> Slot size <br /> Bags cement <br /> GROU nNG Buckets bentonite <br /> 'i D LZ�S Bags sand/gravel <br /> Depth to water Filter Pack type/ ize <br /> Mix Ratio/ �+ �o '`� Surge Block: - y/n ) <br /> Installation Method Discussed wit geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />