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MONITORING WELL INSTALLATION RF—Pur--r <br /> Date: 4 0- 31 101 CONSTRUCTION GI�u IN <br /> Premise Address: Total Depth io <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> (� jI Bentonite (from) (to) <br /> Inspector: _ IC�^�"�� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �� �'1 �{�� Auger O.D. I.D. <br /> U Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company: <br /> Driller: _„_ casing <br /> ��� height <br /> Consultant <br /> LIZIi <br /> Geologist •- T <br /> ABOVE-G8MND <br /> COMPL��-T{ON CNASSTY-80X <br /> CGMPL ET1CN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> = m <br /> SAMPLING a \�it �C.L �(/�� •lor.� _— c <br /> 0 :ectcn <br /> Holding Temperature L <br /> Method �6/:ML t V®A c T_ �E � �- _ 7211W PaCC <br /> Screening Method <br /> Tracking Sheet rn ) " — <br /> �.r.tt. <br /> SPOILS n, D' <br /> Storage Method � �' "� MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location4—, Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterer Bags sand/gravel <br /> Mix Ratios Filter rack type/size <br /> Installation Method Surge Block: - ( y/ ii ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />