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IONITORING WELL INSTALLATION REPO <br /> Date: I" In ti E ;' {. ci CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: �' ' Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: M __ Grout (from) (to) <br /> Drilling rig �e <br /> Permit No. Auger O.D. I.D. <br /> �. <br /> Completion'/- Stove pipe/christie box (circle one) <br /> Drilling Company: 9 Driller: casing <br /> casing <br /> height <br /> Consultant �� <br /> Geologist A.QA JISoVE-GROUND C-�-SSrY-80X <br /> C.OWLETION COMPLETION <br /> SPECIAL PERMIT INFO. G=nd act <br /> Distance to sewer line <br /> Domestic well on site - ( y/(i.] {t. <br /> If yes, location and distance <br /> ALp <br /> C <br /> � O <br /> SAMPLING 8106d c <br /> ,. sacron � <br /> Holding Temperature Qrawt pac#c <br /> Method ?(1 t+ <br /> Screening Method' 1` <br /> Tracking Sheet - T/ n ) <br /> SPOILS <br /> Storage Method �7,"t MATERIALS EVELOPMENT <br /> Contamination Noted -r�/ n } �'[ 3 PV1 CJ <br /> Storage Location ( t L� ' t'L.., C�mg t'P <br /> Blank h. Screen 10ft. <br /> CJ Slot size <br /> GROUPING Bags cement <br /> Buckets bentonite <br /> Depth to water I Bags sand/gravel <br /> Mix Ratios1c-TCS �,- Filter Pack type/size <br /> Installation Method Surge Block: - { y ) <br /> Quantity Installed Discussed with geologist: - �/ n ) <br /> Type of method <br /> EH 29 29 <br />