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MONITORING WELL INSTALLATION REI--eT <br /> Dace: 1/ Old (o / CONSTRUCTION <br /> ?remise Address: SfK� damTotal Depth <br /> Screen. Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> J ^ 0 Bentoni[e (from) (to) <br /> tnspector. l' (!it Grout (from)-(to)- <br /> Drilling <br /> Flom) (to)Drilling rig type <br /> Perini[ No. Auger O.D._ ID. <br /> Drilling Company: <br /> Rst Completion - Stove pipe/cnristie box (circle one) <br /> Driller: casing <br /> CC height <br /> Consultan <br /> Geologist r <br /> A$CVEvRWNO Ct-Rl5'T"!ocX <br /> ccA?!-�,10N COM1PLE-5cN <br /> SPECIAL PERT INFO. G=nd S+jl� <br /> MI <br /> y <br /> 9 ZfUSi <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) t- <br /> lf yes, location and distance - 2 L <br /> 0 <br /> SAMPLING �aaccn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n ) <br /> i D31. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n) <br /> Storage Location Casing type <br /> Blank ft. Steen � <br /> Slot size n d 0 — <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ✓ j Bags sand/gravel <br /> s Filter Pack rype/size <br /> Mix Ratios Z <br /> Mix Ratios Method Surge Block: - (y/ n ) <br /> [nstQuantity Installed Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br />