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\_.MONITORING WELL INSTALLATION REF,��' <br /> Date: Vo- CONSTRUCTION <br /> Premise Address: .S Ly4 22� Total Depth 0-10 <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack om) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig e <br /> Permit No. Auger O.D. I.D. <br /> Completio - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist PON-GACUND MPLIV•10N <br /> SPECIAL PERMIT INFO. Ground Surfac* <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - fL <br /> ft. <br /> J« r <br /> SAMPLING <br /> SIG _ <br /> ^M <br /> a cn . <br /> Holding T perature_ _g oC/ N _ <br /> a. 9M pack <br /> Method a,» `�ul�-c, �� _ <br /> Screening Method A) — <br /> Tracking Sheet - n ) _ <br /> ..,1 — <br /> ft. <br /> SPOILS <br /> Storage Method tl1A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n <br /> Storage Location�l/A Casin e <br /> Blank ft. creep ft. <br /> Slot size <br /> GROU'T'ING Bags cemen <br /> Buckets bent ite <br /> Depth to water. UAL'60-70 Bags sand/gra 1 <br /> Mix Ratios Filter Pack typ ze <br /> Installation ehod Surge Block: (y n ) <br /> Quantity I staked Discussed ith geol ist: - (y/ n ) <br /> Type o ethod <br /> EH 29 2 <br />