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•MONITORING WELL INSTALLATION ART <br /> Date: 5/3 -q/01CONSTRUCTION <br /> Premise Address: }V �u/U^� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: AA t,/ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. �J' "^ 1 Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. IC I.D. 6 t <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> he±ght <br /> Consultant T <br /> Geologist r <br /> ABOVE-GROUND Ci477STY80X <br /> COMPLETION COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surfaca <br /> Distance to sewer line of06 <br /> Domestic well on site - (y/ n }t, <br /> If yes, location and distance - ft. <br /> = o <br /> SAMPLING = <br /> tlotad — c <br /> sackri <br /> Holding Temperature = qnvoa G <br /> ack <br /> Method ; <br /> Screening Method ^ _ <br /> Tracking Sheet • (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) u�,p(I G� <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water _ 0— 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 />