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MONITORING WELL INSTALLATION . ORT <br /> Date: 161 D,� CODWrTRtX � <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 3 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: _#7�1 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: TT casing <br /> Consultant <br /> 4�E height <br /> Geologist �"`�-'�-� <br /> ABOVE-GROUND <br /> COM?LEiION CHR3M_BOX <br /> SPECIAL PERMIT INFO. Ground g�acs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft <br /> ft. <br /> = m <br /> _ a <br /> SAMPLING <br /> tlottad <br /> socton <br /> Holding Temperature <br /> Method ' _ �Ys�Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> ft. <br /> SPOILS <br /> Storage Method _M_ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type °t P Y(-- <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water J (�� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed ti Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />