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MONITORING WELL INSTALLATION RHPO .T z <br /> kw , Mc�3 <br /> a� - CONSTRUCTION <br /> Date: / 1— 4 <br /> � J(� dGl Gv Total Depth <br /> Premise dress: Screen Length (from) <br /> Well No.: Filter Pack (from) (to) / 9 <br /> _ <br /> Bentonite (from) /, _(to) <br /> Inspector. , C Grout (from)--- (to) <br /> pDrilling rig type <br /> Permit No._ , 3 3 O Q 9 Auger O.D. '' 1.D. <br /> Completion - Stove pipe/christie U6-x. (circle one) <br /> Drilling Company:. �Eju _- <br /> { casing <br /> Driller: `` —:F he,ght <br /> Consultant <br /> Geologist <br /> J 2 '•off IN ywvyYu) y e j1�'' CSG/B CflhiPLETiOND C4XR*7Y-3OX <br /> coM.LmcN <br /> SPECIAL PERMIT INFO. Ground Sulam <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ,_ <br /> If yes, location and distance - ft. <br /> 'Z - <br /> - o <br /> SAMPLING slorvd — <br /> io-cicn <br /> Holding Temperature .� _ 9-2 pack <br /> Method = _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) =: <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n <br /> Storage Location Casing type <br /> Blank---- o fr. Screen J�S ft <br /> Slot size C� v <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size Pr ' <br /> -\Installation Method Surge Block: Y n ) <br /> Quantity Installed Discussed with eologist: - (y/ n) <br /> Type of method LLe <br /> EH 29 29. <br />