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MONITORING WELL INSTALLATION REP-e-T <br /> G�lJ <br /> CON SCRUC ION <br /> Date: 2 <br /> �3_ r�_� r � Total Depth <br /> Premise Address: Screen Length (from) <br /> Well No.: Iy' Filter Pack (from) <br /> Bentonite (tom) <br /> Grout <br /> (from) <br /> inspector. 7 <br /> Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cnrtetie box (circle one) <br /> Drilling CompY. <br /> ��$ <br /> A� casing <br /> Driller. height <br /> Consultant r//'F67- <br /> f� t <br /> Geologist A3CVE_GRCUN0 �•y�CX <br /> Stagy CONF°TION COMPUMICN <br /> Ground Serf aea <br /> SPECIAL PERMIT INFO. MNA , <br /> r grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> if yes, location and distance - -�----' <br /> SAMPLING wc:cn <br /> pacx <br /> Holding Temperature =:. __ 7" <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/ LOPMENT <br /> Contamination Noted - (y/ n ) ming type <br /> Storage Location Blank ft. Seen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> N,� Bags sand/gravel <br /> Depth to water Filter Pack typesize <br /> Mix Ratios Surge Block: - C y/ n ) <br /> Installation Method Discussed with geologist: - C y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />