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MONITORING WELL INSTALLATION R) ;T <br /> Date:-44 CONSTRUCTION <br /> � TPremise Address: ZS /c.e�_ Total Depth__Z_2- <br /> l �k Z� Screen Length (from) (to) .� <br /> Well No.: Filter Pack (froth) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> ` <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> v <br /> Driller: casing <br /> Consultantheight_��^""�'`t/ .�� <br /> —GV-f <br /> Geologist _ <br /> ABOVE-GROUND <br /> COMPLETION CFIRZW430X <br /> SPECIAL PERMIT INFO. Ground guru CQMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - - <br /> - A <br /> C <br /> SAMPLING s <br /> &#cion <br /> Holding Temperature : <br /> Method _ 7' PdK* <br /> Screening Method — <br /> Tracking Sheet - (y/n) ` <br /> A. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) t, <br /> Storage Location Casing type_f yu q <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING �p /, Bags cement <br /> Buckets bentonite <br /> Depth to water �C�-1 t� /� 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 />