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%,_�ONITORING WELL INSTALLATION REPL.. f <br /> Date: CONSTRUCTION <br /> Premise Address S 'a Z_ Total Depth Gp <br /> Screen Length (from) (to) C� <br /> Well No.: Filter Pack (from) -(to). � <br /> Bentonite (from) 3 (to) <br /> InspectorGrout (from) 3 (to)#=: <br /> Drilling rig tyLe,Cf Un C p✓57 <br /> Permit No. �/ Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant � � - T <br /> T <br /> Geologist AE&E-GROUND <br /> COMPLETION COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO.Sacs <br /> 75 grout <br /> Distance to sewer line 5M <br /> Domestic well on site - (y/(g) G d — ! 41 ft. <br /> If yes, location and distance - ft. <br /> �+'�r if J }Y.• � <br /> 4 <br /> SAMPLING stoned 'r <br /> soon <br /> Holding Temperature Qnvol pacss <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - (y/ n } 4. <br /> �U ft. 6a ft. <br /> SPOILS <br /> Storage Method - MATERIALS/DEVELOPMENT <br /> Contamination Noted - 7 / n ) <� <br /> Storage Location Casing type <br /> Blank----492—ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 5 D Bags sand/gravel � <br /> Mix Ratios 2-,9 .l _ - Filter Pack type/size " <br /> Installation Method Surge Block: - (y/0) <br /> ) <br /> Quantity Installed �*1[2& U Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />