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,.MONITORING WELL INSTALLATION REPC-P,,- <br /> Date: ")%— CONSTRUCTION <br /> Premise Address: �b 7 /4a"4— Total Depth <br /> ZZ.P 61 Screen Length (from) (to)--3b <br /> Well No.: Filter Pack (from) (to) Z-e— <br /> Bentonite (from) Z$ (to) -Z-f. <br /> Inspector: 4� Grout (from) (to) <br /> C=� �� Drilling rig type <br /> Permit No. (� Auger O.D. 2 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GACUND <br /> CO(�iPLEiION CNAISTY-80X <br /> COMPLETIC <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> I.. C <br /> SAMPLING $loi = c <br /> axon — <br /> Holding Temperature <br /> acK <br /> Method t <br /> Screening Method —_ <br /> Tracking Sheet (y/ n ) j — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) H PVC <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> lot size U W, <br /> GROUTING � ags cement <br /> _ x 4$m bbentonite <br /> Depth to water V Bags sand/gra"I $00 <br /> Mix Ratios ' A Filter Pack type/size 2 <br /> Installation MethoAy Surge Block: - (X'/ n <br /> Quantity Installed Discussed with geo ogist: - ( y <br /> Type of method <br /> EH 29 29 <br />