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MONITORING WELL INSTALLATION R.EPVnf <br /> Date:�I�61 CONSTRUCTION <br /> Premise Address: 0 <.'tCG t Total Depth <br /> Screen Length (from) (to) <br /> Well No.: o �� �^'�` Filter Pack (from) (to) <br /> I+ I Bentonite (from) (to) <br /> Inspector: N i� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> / f Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:, <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist 9 <br /> ABCVE-GACUND <br /> CCMPLETiON CNAtSTY-80X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Surfaca <br /> Distance to sewer line <br /> Grout <br /> Domestic well on site - (y/ n ) RZ __,___:,ft. <br /> If yes, location and distance - ft- <br /> ff. <br /> Y <br /> C <br /> SAMPLING <br /> 6 aocScn <br /> Holding Temature 9 <br /> Method I A&,--j—.T-- <br /> Screening <br /> , —_ <br /> Screening Method = <br /> Tracking Sheet - / 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 />