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Total Depth <br />Seen. Length (from) (to) <br />Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Grout (from) (to) <br />Drilling rig type <br />Auger 0.ID. I.D. <br />Completion - Stove pipe/christie box (circle one) <br /> <br />casing <br />height <br /> <br />ABCVE-GROUND <br />=h421...ETION <br /> <br /> Grzurs:1 Sulacs <br />MONITORING WELL INSTALLATION REI-NaKT <br />Date: in Ofe CONSTRUCTION cm r <br />Premise Address: <br />Well No.:"IA Abk-e-0 _PR) 6 - h - 11 ) CA- E) '7 A -E) <br />U <br />Inspector. <br />Permit No. <br />Drilling Company: <br />Driller <br />ConsultanA <br />Geoyigist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature 16C" <br />Method OA <br />Screening Method L/1 t5G, 1y" <br />Tracking Sheet - /i n ) <br />SPOILS <br />Storage Method 45X a, - <br />Contamination Noted - / ) <br />Storage Location <br />MATERIALS/DEVELOPMENT <br /> <br />Casing type <br /> <br />ft. Blank ft. Screen <br />Slot size <br />GROUTING Bags cement <br />Buckets bentonite -ct B6J) Depth to water Bags sand/gavel <br />Filter Pack type/size <br />Mix Ratios <br />Installation Method Surge Block: - y / n ) <br />Quantity Installed Discussed with geologisr - (y / a) <br />Type of method <br />EH 29 29