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MONITORING WELL INSTALLATION REP- -PtT <br /> CONSTRUCTION <br /> premise Address: 0 6 F?(7 W " ' Total Depth <br /> Screen Length (from)' (to) <br /> Well No. : h'A't,l f Filter Pack (from) (to) <br /> / Bentonite (Ecom) (to) <br /> Inspector: l Grout (&om) (to) <br /> Drilling rig type <br /> Auger O.D. <br /> Permit No. l D• <br /> Completion - Stove pipe/christie box (circle one) <br /> m <br /> Drilling Copany: <br /> 6, - <br /> D 5 casing <br /> height <br /> rr <br /> Consultant �fl Cd � Fr7] <br /> Geologist ABCVE-GRCUNO <br /> CNAIS Y-BCN <br /> CVVFLET{ON <br /> COWL=- , CN <br /> SPECIAL PERMIT INFO . 3urf� T---- <br /> Y <br /> ^ytOCIL <br /> Distance to sewer line l <br /> Domestic well on site - ( y / n ) L <br /> If yes, location and distance - t <br /> 3 <br /> SAMPLING <br /> Holding Temperature <br /> Method tho V0A/ <br /> Screening Method <br /> Tracking Sheet - y v n ) <br /> r = t lL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank ft. Screen lT- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 2 Bags sand/gravel <br /> Mix Ratios Fater Pack type/size <br /> Installation Method Surge Block: - ( Y / n ) <br /> Quantity Installed Discussed with geologist: - ( Y / n ) <br /> Type of merhod <br /> EH 29 29 <br />