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%4.�VIONITORING WELL INSTALLATION REIN ; T <br /> i <br /> Date: r/ <br /> G�YIJI Do CONSTRUCnON <br />` Premise Address: M i/" � n �`^'�/ Total Depth <br /> t � Screen Length (from) (to) <br /> Well No.: 7 S Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: 14r4r /r Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion • Stove pipe/cli istie box (circle one) <br /> Drilling Company: <br /> Driller: easing <br /> he ±ght <br /> Consultant ( b <br /> �EWT <br /> Geologist Igo-t <br /> IVBOVE GACUND CHSZTY43OX <br /> Y J I COAFLETION CCMPLEnCN <br /> SPECIAL PERMIT TNFO. Ground Surtax <br /> i <br /> Distance to sewer line grout <br /> Domestic well on site • ( y / n ) <br /> If yes, location and distance - <br /> It- <br /> M. <br /> SAMPLING <br /> _ _ slorrni <br /> oG axicn k <br /> Holding Temperature = pavdpaGc <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water~ b I 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 />