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MONITORING WELL INSTALLATION RE!,,KTTOK <br /> JV <br /> Date: CONSTRUCTION <br /> � � <br /> ?remise Address: Total Depth S=een Length (from) (LO) <br /> Well No.: w st Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> �� Grout (from) (to) - <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion -Stove Pipe/christie box (circle one) <br /> � <br /> Drilling Company <br /> t <br /> l <br /> qq C I� w casing <br /> Driller•. 1,� IP �" TTheight <br /> J Iff <br /> Consultant v��iV, V" T <br /> Geologist ABCVE" CUNo <br /> CHALS—I y-30X <br /> c--4APL="i,CN <br /> Ground Stsfaa <br /> SPECIAL PERMIT INFO. , <br /> gr <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> if yes, location and distance - <br /> 73 <br /> :b <br /> SAMPLINGZ C Q.�S cn F"! _ � <br /> Holding Temperature J ? <br /> Method (,1� <br /> Screening Method_ — <br /> Tracking Sheet - C y/ n) <br /> 1i. <br /> SPOILS <br /> MATERIALS/DOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft- Screen fr <br /> Slot size <br /> UTING Bags <br /> GROcement <br /> /1�� � Buckets bentonite <br /> Depth to water—! to l S Bags sand/gravel <br /> Filter Pack typesize <br /> Mix Ratios Surge Block: - (y/ n ) <br /> Installation Method - Discussed with geologist: - ( y/n) <br /> Quantity Installed Type of method <br /> EH 29 29 f r\ r� <br />