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MONITORING WELL INSTALLATION Rl P&T <br /> Date: OV3, CONSTRUCTION <br /> Premise Address: <br /> Total Depth Sd <br /> Screen Length (from) S (to) ' <br /> Well No.- _ _ Filter Pack (from) 9'0 (to)_47 <br /> Bentonite (from)_ 3 (to) 1 <br /> Inspector: / Grout (from) (Ej (to) <br /> Drilling rig type_u' S <br /> Permit No. Auger O.D. I.D. ' <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: IjIff <br /> Driller: P ,5_1 'Lb casing <br /> �/� height <br /> Consultant A6c -a <br /> Geologist AV� �A"rk' -- ,�,gpy�AROUND T . <br /> COMPLETION C#�i 8 <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer liner//1 grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - / . <br /> � lt. <br /> . — <br /> s! d <br /> aF 5 <br /> ' � O <br /> SAMPLING dotted Wr = c <br /> d vection <br /> Holding TemperatureG VzyW packr <br /> Method 5 „Q <br /> Screening Method Yll) _ <br /> Tracking Sheet - (6/ n] <br /> B. <br /> SPOILS <br /> Storage Method 55' MATERIALS/DEVELOPMENT <br /> Contamination Noted ly/ <br /> Storage Location �. � u Casing type <br /> Blank �N ft. Screen_ <br /> SIot size- h•OZ <br /> GROUTING Bags cement <br /> Buckets bentonite I <br /> Depth to water 30' Bags sand/gravel <br /> Mix Ratios Filter Pack type/size ��- <br /> Installation Method iLc Surge Block: - (y/ n ] <br /> Quantity Installed /0. 1 Discussed with geologist: /n ) <br /> Type of method <br /> EH 29 29 <br />