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MONITORING WELL INSTALLATION RET T <br /> Date: ` CONSTRUCTION <br /> Premise Address: ��� X77 Total Depth <br /> Screen Length (from) (to) <br /> Well No.) Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: PJU L Uw`-C. <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist T <br /> ou 1180VE-DR0UND <br /> COIv1i'LETION CNRJM43OX <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line afoul <br /> Domestic well on site - (y/ n) ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> = m <br /> SAMPLING <br /> �Qslotted � <br /> ° bL sections _ <br /> Holding <br /> Temperature = . <br /> Method _ V"01Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> fL r = <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ��� J� <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size r?-O Zb <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 2 Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Method Surge Block: - (yn <br /> Quantity Installed Discussed with geo ogist: - n ) <br /> Type of method <br /> EH 29 29 <br />