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ti <br /> ITORING WELL INSTALLATION1. .ORT 1V <br /> CONST�N i. <br /> Date: <br /> Total Depth Cto) ' <br /> Prem se Address: Screen Length Cfrom)�—(to) <br /> Filter Pack Cfrom)-�Cto) <br /> Well No.: Bentonite Cfroin)—( <br /> Grout (from):L <br /> Inspector: Drilling rig tyPa <br /> Auger O.D. , <br /> permit No. Completion- Stove pipe/rhnstie box (circle one) <br /> Drilling Company: <br /> casing <br /> height <br /> Driller: <br /> Consultant <br /> XEOVE-GROUND <br /> Geologist GI6�457Y�oX <br /> CayPLE'TV4 COMPLETION <br /> 7 6rWr�dSurface <br /> SPECIAL PERMIT INFO. grout <br /> ft. i <br /> Distance to sewer line tt <br /> If yes, location and distance- tt, _ <br /> i <br /> jL <br /> ,• <br /> Pie <br /> [b sd <br /> s. 2 <br /> SAMPLING wc6on _ <br /> grave{ pad, <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Trackin.9 Sheet - C Y/n) <br /> SPOILS RIALg/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- C y/n) Casing type $ Screen_�fr• <br /> Storage Location Blank--� <br /> Slot size <br /> Bags cement <br /> GRGR�G Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Packtype/size <br /> Mix Ratios _ Surge lock:=(.Y-/—n-) <br /> Installation Method Discussed with geologist: - C Y/ n) <br /> Quanti{y Installed Type of method <br /> EH 29 29 <br />