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�ITORING WELL INSTALLATION i. .ORT <br /> CONST ON i <br /> Date: ' <br /> Total Depth (to) <br /> Premise Address: Screen Length Cfr'om)�—Cto) <br /> Filter Pack (from)--(to) <br /> Well No.: Bentonife' Cfrom)— � <br /> Grout Cfrom) �(to) <br /> Inspector: Drilling ng type I.D. -- <br /> Auger O.D. <br /> Permit No. Completion- Stove pipe/chrtstie box (circle one) <br /> Drilling Company: <br /> casing <br /> height <br /> Drillez: <br /> Consultant <br /> Geologist 160VEGRC)CR 0 <br /> COMPLETION 4 <br /> COIh'LEfioN COMPLEi7GN 1, <br /> ��� 6rourd Suixre 7—� , <br /> SPECIAL PEF T INFO, proof <br /> Distance to sewer line ft <br /> If yes, location and distance- g, <br /> JL <br /> - ilattad _ _ � • <br /> S6LaLING on <br /> . =_ peavd Pads <br /> Holding Temperature <br /> Method 'lir". <br /> Screening Method <br /> Tracking Sheet • (Y/n) tt — ' <br /> SPOILSEyEhOPMENT <br /> MATERSALS/D <br /> Storage Method <br /> Contamination Noted - (y/n) Casing type <br /> ft Storage Location Blanker Screen ft' <br /> Slot size <br /> Bags cement <br /> GR_ O� Buckets bentonite <br /> • Bags sand/gravel <br /> Depth to water Filter Packtype/size <br /> Mix Ratios _ Silrge-Block:_CY--/_n3 <br /> Installation Method .,_ Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br /> l . <br />