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MONITORING WELL INSTALLATION ART <br /> Date: CONSTRUCTION <br /> n / CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: wt -3 Filter Pack (from) (to)b <br /> 1 Bentonite (from) (to) <br /> Inspector. r"'�'t�( Grout (from) <br /> Drilling rig type �S <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> _ T <br /> Geologist ABCVE-GRCUND <br /> COMPLETION c4xA -=ncN <br /> CCMPI.ETICN <br /> SPECIAL PERMIT INFO. Ground SuAx� <br /> Distance to sewer line RE <br /> grout <br /> Domestic well on site - ( y/ n ) _ft. <br /> If yes, location and distance - / 7o g, <br /> _Zrt. <br /> ci = <br /> as <br /> — o <br /> SAMPLING �lotai <br /> soricn — <br /> Holding Temperature �,,�Pack <br /> Method ''• __ <br /> Screening Method <br /> M <br /> Tracking Sheet - (y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ei / <br /> Storage Location Casing e <br /> Blank ft. Screen ft. <br /> Slot size O . 020 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water A 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 />