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INITORING WELL INSTALLATION I- . ORT <br /> V <br /> CONSTRUMON <br /> Date: <br /> Total Depth Cto) k <br /> Premise Address: Screen Length (from) <br /> Filtet Pack Cfrom) (to) j <br /> Well No.: Bentonite' Cfrom) (to) <br /> Grout Cfrom) '(to)- <br /> inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion-Stove pipe/cbristie box Ccircle one) <br /> Drilling Comp 'any: <br /> casing <br /> Driller: Jill height <br /> consultant------------------ <br /> ._ I <br /> Geologist Ai; G}-R}7T BOX i <br /> cowpL.ET}ON coMPLEnoN t <br /> C-sruc.irs�5urixa <br /> SPECIAL PERMIT INFO. ;rout t <br /> Distance to sewer line h, t <br /> 1 ff. <br /> } <br /> If yes, location and distince- <br /> O ' <br /> L}Olk _ <br /> SING Lacon ._ <br /> grays}pack <br /> Holding Temperature <br /> Method <br /> Screening Method , <br /> n <br /> Tracking Sheet - C y/ ) <br /> • —ft. <br /> it. <br /> SP OILS =6 <br /> MATEa T eT_S/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- C y/n) Casing type ft. <br /> Storage Location Blank ft Scre n <br /> Slot size <br /> Bags cement <br /> GROLMNG Buckets bentonite <br /> Bags sand/gm9e <br /> Depth to water Filter Park type/size <br /> Mix Ratios _ �• Surge_B_lock:=(-y_/—n-)- <br /> Instal!atiOn <br /> -n-)Installation Method Discussed with geologist: - Cy/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 - <br />