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f <br /> *MO <br /> NITORING WELL IN RF-PUT / <br /> Date: <br /> Premise Address: 7) P CONS nON <br /> `,' � Total Depth_ <br /> Well No.: <br /> f Screen Length (from) <br /> Inspector. Filter Pack (from)--- —(to)--- <br /> --------- <br /> _ <br /> Bentonite — —(to) <br /> Grout rig type( om)�_(Co)—� <br /> (from) <br /> Permit No. Drilling ( om) (to)-- <br /> ltit`_ <br /> Drilling Company: 1 A / Auger O.D. <br /> Com lotion -�—' I.D. <br /> V //P Stove pipe/duistie box (cir�e� <br /> Driller. C� (✓� r = : <br /> Consultant Jt�u � casing <br /> height <br /> Geologist St <br /> ABOVE-GftCUND <br /> SPECIAL PERMIT INFO. CONFLETJON C>O*'Ty-aox <br /> Ground Suiact `TON <br /> Distance to sewer line .�, -----� <br /> Domestic well on site <br /> If yes, location and distance - <br /> ft. <br /> ft. ft. <br /> — m <br /> SAMPLING <br /> Holding Temperature socicn = B <br /> Method _— <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS -R. - ft. <br /> Storage Method <br /> Contamination Noted - (y/n) MATERIALS/pEVEI OPMENT <br /> Storage Location / LSI / <br /> Casing type IS <br /> BlancScreen h, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water It6+- Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> installation Method 77i o -9. Filter Pack type/size <br /> Quantity Installed Surge Block: - (y <br /> Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />