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MONITORING WELL INSTALLATION RET <br /> Date: - C7 r CONSTRUCTION f� <br /> Premise Address: <br /> [ (p S Total Depth `'` <br /> Screen Length (from) o (to) v <br /> Well No.: A) Filter Pack (from) (go (to)� <br /> Bentonite (from) (to) <br /> Inspector. o 1. - Grout (from) (to)__ <br /> Drilling rig type- f C 'iS I-FS <br /> Permit No. Auger O.D. I.D. <br /> p Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: X47(1 (epv Z - Tcas in <br /> T height <br /> Consultant '4 —QV, <br /> Geologist 1 M <br /> ABOVEGROUND CNAtM-SOX <br /> COMPLETION CGMPi-.MON <br /> SPECIAL PERMIT INFO. Grmnd Su we <br /> Distance to sewer Zine <br /> grout <br /> Domestic well an site - ( y/ n ) it. <br /> If yes, location and distance - . <br /> tt. <br /> .a, m <br /> v <br /> q <br /> i� <br /> SAMPLING �IoC.ai G <br /> secicn <br /> Holding Temperature _ <br /> ck <br /> Method ' _ gav�W <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/ n ) - <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />