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MONITORING WELL INSTALLATION RL_ JRT <br /> .Q <br /> Date: 3 Zlo /2 CONSTRUCTION <br /> Premise Address:625-s­ �, Aac" Total Depth (bmJJ--P_X 4 <br /> // Screen Length (from) (to) <br /> Well No.: '57—K — -7 `I Cit &J, Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> 500 �� S Drilling rig type <br /> Permit No. Auger O.D. /2 of �ID <br /> Drilling Company: 0�6S Completion - Stove pipe/christie box (circle one) <br /> Driller: 0S6->' casing <br /> height <br /> Consultant�(� <br /> Geologist 7�l w <br /> ABOVE-GROUND <br /> 0OWLET;0N CHAISTY 80X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line Grp <br /> Domestic well on site - (y/ n ) 1 ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> = o <br /> O <br /> , � m <br /> C <br /> SAMPLING <br /> •lotted c <br /> &*c=n — <br /> Holding Temperature <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type � YeA, 000 <br /> Blank/X 14ft. Screei-0 ft. <br /> Slot size D. D D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method- <br /> Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - 10/ n ) <br /> Type of method V <br /> EH 29 29 <br />