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MONITORING WELL INSTALLATION T <br /> Date: I/I�`�I �� CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. (, <br /> �Sefil,( <br /> Cetn - Stove a/christie box (circle one) <br /> Drilling Company: <br /> Driller: cas' g <br /> hei ht <br /> Consultant pA t, <br /> Geologist OU <br /> 'i lONCHRSM43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacr + <br /> eDistance to sewer lingrout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> �b ft. � ft. <br /> = m <br /> _ <br /> SAMPLING slated = c <br /> sac9on — <br /> Holding Temperature <br /> 7AVVI Pack <br /> Method _ <br /> Screening Method _ <br /> Tracking Sheet - (y/n ) <br /> SPOILS 7� b <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n) „ <br /> Storage Location Casing type ��- <br /> Blank___._ 50. _ft. Screen 2 <br /> Slot size 0.a 10 <br /> GROUTING Bags cement <br /> i <br /> Buckets bentonite 5(O <br /> Depth to water `� _ Bags sand/gravel <br /> MixRatios Filter Pack type/size IIIZ <br /> Installation Method Surge Block: - (y/0) <br /> Quantity Installed Discussed with geologist: - (b/ n ) <br /> Type of method <br /> EH 29 29 <br />