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MONITORING WELL INSTALLATION RE:,.,T <br /> Date: 13 I I CONSTRUCTION / <br /> Premise Address: Total Depth <br /> Screen Length (from) --4-0 _(to) <br /> Well No.: Filter Pack (from) a-0 (to) <br /> Bentonite (from) �41 (to) 3 ' <br /> Inspector. Grout (froth 2 h (to)� <br /> Drilling rig type hrVi°� :�. <br /> Permit No. -I Auger O.D. I.D. <br /> 1 1 Ar� ���.t.�� Completion - Stove pipe/cl stie ox ircle one) <br /> Drilling Company: l A l(T'tr�7��� �..— <br /> Driller: PJA. ' S4_Yl)loA_�t� casing <br /> Consultant height <br /> � '4 <br /> Geologist� t C p <br /> ABOVE-GFiCUNO CNAtSTY-30X <br /> CX)A�LcT10N CCMPL-=nCN <br /> SPECIAL PERMIT INFO. Ground Strfaer <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ ni Y; <br /> If yes, location and distanIt. <br /> h. <br /> h. <br /> — a <br /> = e <br /> SAMPLING <br /> slonai = � <br /> sac:cn - <br /> Holding Temperature _ G <br /> Method <br /> Screen inz Method 1 = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method U' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n / i( p , ` C <br /> Storage LocationP �� Casing type (p r V 1 <br /> Blank�c ft- Screen <br /> Slot size D Y <br /> GROUTING Bags cement %3 <br /> Buckets bentonite I <br /> a <br /> Depth to water Bags sand/gravel 10 Lo <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />