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MONITORING WELL INSTALLATION REP04/ <br /> y,. <br /> Date: 0 CONSTRUCTION <br /> Premise Address: 4il� <br /> Total Depth <br /> Screen Length (from) (to) 7= <br /> Well No.: Filter Pack (from) A4 0 (to) Z! _ <br /> Inspector. Bentonite (from) (to) <br /> Grout (from) I (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. ` <br /> Completion • love pipe/christie box (cirelt one) <br /> Dulling Company: <br /> Driller. i <br /> casing <br /> height <br /> Consultant IV_ <br /> Geologist o .. ' <br /> 00MPLEfiON t.CtALl71:IN <br /> SPECIAL PERMIT INFO. t3wund$asiaa <br /> Distaste fit tower line tip <br /> Domes&weil on site - (y/ n) <br /> If yes, location and distance - <br /> SAMPLING tbrao = 3 <br /> sacdcn M = <br /> Holding Tempera e <br /> Method <br /> Screening Method <br /> Tracking Sheet y n) <br /> SPOILS , <br /> l <br /> Storage Method ff G AMPIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location__�,1 B a a ft Scrden <br /> '. <br /> Slot size t D <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �� Bags sand/gravel <br /> Mix Ratios <br /> Filter Pack type/size <br /> installation Method Surge Block: - (y/ <br /> Quantity Installed Discussed with geologist: . g n ) <br /> Type of method <br /> EH 29 29 <br /> �. �/�` <br />