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MONITORING WELL INSTALLATION REFI' <br /> Dater/ i T �� CONSTRUCTIO <br /> pN <br /> Premise Address: Z ! i Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 3''�T f �D � F�20 Filter Pack (from) (ta) <br /> Inspector: d o(jl Bentonite (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> I <br /> / Completion- Stove pipe/christie box (circle one) <br /> Drilling,Company: (yi- -J- <br /> Driller: casing <br /> height <br /> Consultant_/�.GMM.� , �,B// nn <br /> Geologist Ai(Cc, � CRAY <br /> ABOVE-GROUND <br /> OOMPLEfION CHAISTY BOX <br /> SPECIAL PERMIT INFO, OOMPLEnON <br /> Ground Surlace <br /> Distance to sewer linegrout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - 8oIS ft. <br /> 0 ft. ft• <br /> — m <br /> — o <br /> SAMPLING — o <br /> [L ■lotted — 'c <br /> Holding Temperature_Z tib soon <br /> Method <br /> Screening Method = <br /> Tracking Sheet - (/y/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 56-(D Bags sand/gravel <br /> Mix Ratios AA Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />