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MONITORING WELL INSTALLATION REI -e-T <br /> l� I�G i <br /> Date: �' /� / CON "UON <br /> ?remise Address: / �— �, �• rj Total Depth <br /> ? l Steen Length (from) (to) <br /> Well No.: �- ) Filter Pack (from) (to) <br /> Benronite (From) (to) <br /> inspector. Grout (from) (to) _ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> /7 Completion - Stove pipe/cnristie box (circle one) <br /> Drilling Company: � ��`'� <br /> casing <br /> Driller._ height <br /> 17 <br /> Consultant V <br /> Geologic x ° ABCyE_GRpUND <br /> CC&F_cTSON C---W Z C X <br /> AAPL i CCN <br /> SPECIAL PERMIT INFO. <br /> r ' <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n )If yes, location and distance - `L <br /> O <br /> a <br /> a <br /> SAMPLING <br /> wc= = _ <br /> Holding Temperature = ' <br /> Method _ <br /> Screening Method - <br /> Tracking Sheet - ( y/ n ) <br /> !L ♦ — Y tt. <br /> SPOILS <br /> Storage Method MAS /D�LOPMENT <br /> Contamination Noted - (y n ) _ <br /> Storage Location Casing type <br /> Blank ft. Sm'een fE. <br /> Slor size <br /> GROUTING Bags cement <br /> Buckets bentonite — <br /> Depth to water - )Bags sand/gravei' <br /> Mix Ratios A! � ?'•� �- - � Filter Pats typesize <br /> ISurge Block: - (y/ n <br /> Installation Method ) <br /> Discussed wi <br /> Quantity Installed th geologist: - ( y — <br /> Type of method <br /> EH 29 29 <br />