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I el <br /> MONITORING WELL INSTALLATION RF. -itr <br /> Tr-eDate: CONSTRUCTION <br /> W Z Total Depth <br /> ?. remise Address: <br /> Steen Length (from) (to) <br /> Well No.: 4J ( Filter Pack (from) _(to) <br /> Bentonite (Prom) (to) <br /> (j() D Grout (from) _(to) <br /> [nspector: Drlling rig type —. <br /> Auger O.D. I.O. <br /> Permit No.--- <br /> o. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company-__A&i_��4�V �k A2 I <br /> �7 lC casing <br /> Driller. /� height <br /> Consultant_,,, ��' <br /> Geologist �� YE-Gi� ND q��;^!BCX <br /> trP!.�T S0N C_-uP�.-i,CN <br /> G=ru d su lacs <br /> SPECIAL PERMIT INFO. <br /> Z�out <br /> Distance to sewer line �- <br /> Domestic well on site - ( y/ n ) <br /> If,yes, location and distance - <br /> 3 <br /> e <br /> O <br /> tic tad `a <br /> SAMPLING wc:cn <br /> 7xvsl pack <br /> Holding Temperature <br /> �a — <br /> Method <br /> Screening Method —_ <br /> Sheet - (y/ n) _ <br /> Tracking L <br /> SPOILS <br /> ERIALEVEL <br /> S/DOPMENT <br /> Storage Method I <br /> Contamination Noted n ) ming type <br /> Storage Location Bl ft Wean fr- <br /> Slot size <br /> Bags cement <br /> GROU'i-ING j Buctiets bentonite <br /> Bags sand/grav <br /> Depth to water Filter Pack size <br /> Mix Ratios Surge Blo - C y/ n ) <br /> Installation Method Discuss with geologist. _ C y/ n} <br /> Quantity Installed Typ method <br /> EH 29 29 Cj <br /> ld <br />