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• MONITORING WELL INSTALLATION •RT <br /> 140, <br /> Date: CONSTRUCTION <br /> s o nn Total Depth <br /> Premise Address: % l � <br /> ��!lr►it Cil Seen Length C&om)_-�0 <br /> Well No.: Filter Pack Cfrom)_���_Cto) <br /> Bentonite (from) Cto) <br /> Grout (from) (t() <br /> Inspector: Doming rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: -- <br /> casi.nQ <br /> Driller: I height <br /> I <br /> � <br /> Consultant �y3 ti = <br /> r� W <br /> � <br /> Geologist ABCVE.9ACUNO CaaAtSy3Cx <br /> CCM?' TCN <br /> ��.G=nd sulace T— <br /> SPECIAL PERMIT INFO. <br /> Qrout <br /> Distance to sewer tine L <br /> Domestic well on site - C Y/ n ) IL <br /> If yes, location and distance - 4 <br /> r <br /> O <br /> Maned <br /> SAMPLING aac-cn ;mVQ1 pack <br /> Holding Temperature <br /> Method <br /> Screening Method - <br /> Tracking Sheet - Cy/ n ) <br /> SPOILS <br /> MATERIALS/DEVELOPMENT )) V C <br /> Storage Method <br /> Contamination Noted - C Y/ n ) ming type zi <br /> Storage Location L o Blank fr Screen_ ft <br /> SbI $sw�.•��Q S �� Slot size <br /> q�� � l Bags cement <br /> GROUT NG �`O�y Buckets bentoaire <br /> Bags sand/grave! <br /> Depth to water Filter ?ark e/s' e <br /> MLe Ratios Surge Block: - C y n ) <br /> installation Method Ducssed a ologisr. y/ n ) <br /> Quantity Installed Type of methoEH 29 29 29 /� <br />