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MONITORING WELL INSTALLATION Ry_ T <br /> Date: <br /> 4" <br /> CONSTRUCTION <br /> Premise Address: f..r b Total Depth <br /> Well No.: Seen Length (from) (to) _ <br /> l Filter Pack (from) (to) <br /> Inspector. !� Bentonite (from) (to)_ <br /> Grout (from) (to) <br /> Permit No. Drilling rig type — � <br /> Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Driller: casing <br /> Consultant height <br /> T-tL 11 <br /> Geolpfist _ <br /> ABOVE-GROUND <br /> COALITION CMRZTY-BOX <br /> SPEqAL fflUVIT WO. COMPLETION <br /> Grand Strfaca <br /> Distance to sewer line p+ <br /> Domestic well on site - (y/n). <br /> If M.location and distance - ft. <br /> tL <br /> . = e <br /> SAMPLM <br /> Holding Temperature _ <br /> Method : = gmvW pack <br /> Screening Method <br /> Tracking Sheet - (y/n) NK <br /> EPOILS <br /> Storage Method MA <br /> Contamination Noted- (y/n <br /> Storage Location Caste type <br /> Blank ft. Screen ft. <br /> 1 Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> 1, Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Wtnstanation Method Surge Block: - (y/n) <br /> ity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> 12929 <br />