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MONITORING WELL INSTALLATION IMPORT <br /> Date: / CONSTRUCTION <br /> -t4 <br /> Premise Address: 7G? Total Depth z �— <br /> �, I Screen Length (from) (to)�r_ <br /> Well No.: Filter Pack (from) (to) 2 <br /> Bentonite (from) /•J- -(to)T— <br /> Inspector: ��'�-� Grout (from) (to) <br /> f� D058/S Drilling rig type <br /> Permit No. Auger O.D. /D I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller:_ C9t, casing <br /> height <br /> Consultant iY/ <br /> —EFWT <br /> Geologist �f�KuA1 .- <br /> ABOVE-GROUND <br /> COMPLETION CHR1STY43OX <br /> SPECIAL PERMIT INFO. Ground Striata COMPLETION _ <br /> Distance to sewer linegrout <br /> ON <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - <br /> . ft. <br /> ft. <br /> SAMPLING _ <br /> slotted — c <br /> sacdon — <br /> Holding Temperature y <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/n) C <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type_ <br /> Blank ft. Screen ft. <br /> Slot size - O/ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <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 />