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, f <br /> MONITORING WELL INSTALLATION REP-e-T <br /> Date: CONSTRUCTION <br /> � <br /> Premise Address:o/tr�� f a"`"V �J Total Depth <br /> Steen Length (from) (to) <br /> Well No.: v o?"'' 1 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> IbJnn Grout (from) (to) <br /> inspector- <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> . cas Lag <br /> Driller- <br /> height <br /> Consultan <br /> Geologist AVE-GRCUNO <br /> CC&S?!�T'AN <br /> COdPL=-,JCN <br /> SPECIAL PERMIT INFO. G=nd Safaes <br /> r <br /> ytoc.2 <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - - <br /> n s <br /> 11-'✓' � RQd 1JD '" ) W' i10w. o <br /> SAMPLING <br /> t &*Cscn <br /> Holding Temperature T <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ;� ♦ — T tL <br /> SPOILS Wnj <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> YL �6� Bags sand/gravel <br /> Depth twater Filter Pack typesize <br /> Mix Ratios <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />