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gONITORING WELL INSTALLATION REPO <br /> Date: <br /> _ CONSTRUCTION <br /> Premise Address: �� �iJc Total Depth <br /> 6 Screen Length (from) �_(to) <br /> Well No.: Filter Pack (from)3_(to) F <br /> kE <br /> Bentonite (from) 3 (to) �5 <br /> Inspector: Grout (from) 35 (to) O <br /> © 5�9�/ Drilling rig type_ u 75 <br /> Permit No. Auger O.D. q I.D. 4 <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> �� <br /> Driller: "�'`Q- — <br /> casing <br /> height <br /> Consultant <br /> T <br /> Geologist ABOVE-GROUND <br /> CONFLETION <br /> SPECIAL PERMIT INFO. ppb g�xy T <br /> OMPLE <br /> oN <br /> Distance to sewer line ALJ grout <br /> Domestic well on site - (y n s ft. <br /> If yes, location and distance - ft <br /> �ft. <br /> A <br /> 0 <br /> SAMPLING <br /> sloctad = � c <br /> /(r axtion = <br /> Holding Temperatures y C <br /> Method 9"11W Pack <br /> Screening Method nksr� <br /> Tracking Sheet - (y n ) <br /> ft- <br /> SPOILS <br /> Storage Method rc7`� ` MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n t t 1 `1 <br /> Storage Location bc�-t, Casing type Z -46Y <br /> Blank ft. Screen ft. <br /> Slot size ozz" <br /> GROUTING q?'�Bags cement - <br /> Buckets bentonite ^7i t F- _ kkzd <br /> Depth water ^j -5c)7 Bags sand/gravel 70r7 <br /> Mix Ratios u QQ Z Filter Pack type/ ' e <br /> Installation Method Surge Block: - y/ n ) )()A"t r <br /> Quantity Installed '5O Discussed with geologist: - (y n ) <br /> EH 29 29 Type of method ka.,.l <br />