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; ! 10 <br /> MONITORING WELL INSTALLATION REF-.eT <br /> Date: (�2// J� �P �w��� CONSTRUCRON <br /> Premise Address: -2375 //1ae� t Xo Total Depth <br /> Screen Length (from) (to) <br /> Well No.: �� w S Filter Pack (From) (to) <br /> Benronire (from) (to) <br /> (nspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger OD. I-D• <br /> Completion -Stove pipe/christie box (circle one) <br /> D ' ling Company: <br /> casL. _ <br /> height <br /> Consultant" - ♦� � � <br /> _ t <br /> Geologist <br /> /18CVEvRCUND q.AtST!-30X <br /> CCNFLMN CCMPt—LCCN <br /> Slxf <br /> SPECIAL PERMIT INFO. C'fOUnd "' <br /> r ' <br /> Distance to sewer line <br /> Domestic well on site - ( y/ a ) <br /> If yes, location and distance - <br /> 3 <br /> 0 <br /> SAMPLING 11ca2d <br /> Holding Temperature ;nw+pack <br /> Method — <br /> Screening Method <br /> Tracking Sheer - (Y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOP <br /> Contamination Noted - ( y/ a ) <br /> Location Casing type <br /> Storage <br /> Blank ft Screen � <br /> Slor size <br /> GROUTING / Bags cement <br /> f / Buckets bentonite <br /> , <br /> Depth to water / — Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Merhod Surge Block - (y! n ) <br /> Quantity Installed Discussed with geologist - C Y <br /> Type of method <br /> EH 29 29 <br />