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MONITORING WELL INSTALLATION F ' SRT <br /> 2-7, 11 <br /> Date: I I CONSTRUCTION <br /> Premise Address: `� �_ . fil`- . �L•"� Total Depth S <br /> Screen Length (from) 7 (to) <br /> Well No.: Filter Pack (from) Z S (to) <br /> Bentonite (from) `/ (to) 2 <br /> Inspector: ('�% M P '`�� Grout (fro t) (to) <br /> Drilling rig types + i <br /> Permit No. Auger O.D. / /' I.D. </ <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: //A ) T casing ; <br /> Consultant <br /> 1 heigh <br /> Geologist - <br /> ABOVE-GROUND CHRMTY-BO% / <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line U^' grout <br /> Domesric well on site • ( y /'fin )' <br /> If yes, location and distance - n. <br /> ` w n. <br /> n. <br /> T <br /> SAMPLING abttad _ SE <br /> socton - — <br /> Holding Temp9ptune s l� <br /> Method gr'v°IPack <br /> Screening Method PL;\ _ <br /> Tracking Sheet - � / n ) <br /> tL <br /> SPOILS <br /> Storage Method /?� ��d TERIALS/DEVELOPMENT <br /> Contamination Noted n ) a Axis <br /> Storage Location m_ < : v Casing type -� <br /> Blank �> ft. Screen 7 i9 f <br /> Slot SET(- <br /> GROUTING Bags cement <br /> Buckets bentonite ` <br /> Depth to water O ' Bags sand/gravel } - ' <br /> Mix Ratios Filter Pack type/size .Z / U <br /> Installation Method Surge Block: • ( y knj <br /> Quantity Installed Discussed with geologist: - (yam n ) <br /> Type of method <br /> EH 29 29 <br />