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MONITORING WELL INSTALLATION REP-KT <br /> Date: <br /> o v , L oo t CONSTRUCTION , <br /> ?remise Address: ( JI ✓"CA 4�-r Total Depth (to) <br /> Screen Length (from) <br /> �. 1 Filter Park (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Q IJ Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie01 <br /> box (circle one) <br /> Drilling Company: <br /> Q� t casing <br /> Driller. r\ Q'r"\ <br /> he; <br /> Consultant <br /> Geologist /IBCYE-GROtJNO q.MS^vgCX ' <br /> tom!°'FAN comet:,,CN <br /> Gr=g1d Sirf ace <br /> SPECIAL PERMIT INFO. , <br /> Distance to sewer line �- <br /> Domestic well on site - ( y/ n ) fL <br /> If yes, location and distance - S C�jI <br /> SAMPLING wcca7XV91 pack <br /> Holding Temperature <br /> Method lSl U`f <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS � �f � <br /> p MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank ft- Screen �- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack typesize <br /> M- ix Ratios Surge Block: - C y/ n) <br /> Installation Method Discussed with geologist - C y/ a) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />