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MONITORING WELL INSTALLATION R IRT <br /> Date:Gg CONSTRUCTION <br /> i <br /> ' <br /> Premise Address: 7/Z SSC Total Depth <br /> L Screen Length (from) (to) <br /> Well No.: Z d-6rA-''c{ j A^S CI f Filter Pack (from) (to) <br /> __ e / Bentonite (from) (to) <br /> Inspector: C//A4& Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: "" Completion - Stove pipe/christie box (circle one) <br /> �U� <br /> Driller: casing <br /> �C�/ � height <br /> Consultant /' ,rye <br /> PTA <br /> Geologist �u -�^ /'�c �G{ d.,� ,_ 7F <br /> ASOYE-GROUND <br /> COWLETCN CNRSSTY-80X <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line �,t/ S Dry <br /> Domestic well on site - (y/ n ) l5 QS� <br /> If yes, location and distance - n• <br /> � ff. <br /> L <br /> q <br /> - m <br /> = C <br /> SAMPLING ilottad ° <br /> aac�on '— <br /> Holding Temperature — P <br /> Method — <br /> Screening Method <br /> .J� <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method �S MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n ) <br /> Storage Location 6-,,- Casing type{ S� � <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement5S 9 <br /> Buckets bentonite <br /> Deep e Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed S 2-01 7 w c QHS Discussed with geologist: ( y/ n ) <br /> Type of method <br /> EH 29 29 '-/ 26d �' <br />