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—MONITORING WELL INSTALLATION REPMT <br /> Date: T// (J) CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No., Filter Pack (from) (to) <br /> Bentonite (from) (to) -L' <br /> Inspector: _. � Grout (from) Z {to) <br /> Drilling rig typ <br /> Permit No. Auger O.D. __„- I.D. <br /> ,1 Completion - Stove pipe/christie b x (circle one) <br /> Drilling Company:_ <br /> Driller. Gas ng ., _,..���'-`•--� <br /> F he,*ght <br /> Consuultant °� z <br /> Geologist <br /> Aj$C -GRMND ` G iiSTY-64X /fr <br /> t:UMFI_EI•iOM <br /> SPECIAL PERMIT INFO. Ground Solace • "� �N� <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> ft. <br /> If yes, location and distance - <br /> ft. <br /> M. <br /> M <br /> 'F <br /> SAMPLING aioroi c <br /> � sQc'icn � <br /> Holding Tem erasure <br /> od �v�t F <br /> Meth <br /> Screening Method <br /> Tracking Sheet <br /> C <br /> SPOILS j -- --- <br /> Storage Method MATE MALS/DEVE LOPMENT <br /> Contamination Noted --T{ y/ ) C! �. <br /> Storage Location ll /�'z� '' res ��"'� Casing e � <br /> Blank ft. Screen <br /> Slot size <br /> GROUI1NG Bags cement <br /> Buckets bentonite <br /> Depot to water Bags sand/gra�el <br /> Mix Ratios ./� �_ Filter Pack type/size <br /> Installation Method 44' . CA:,g _.____ _ Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geol gist: - n } <br /> Type of rnetliod <br /> F-H 29 29 <br />