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z <br /> MONTTORING WELL INSTALLATION PLUM <br /> Date: 7� b'1 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> I II Bentonite (from) (to) <br /> Inspector. Wtv / Grout (from) (to) <br /> Drilling rig type <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 b.p�-• - <br /> Geologist p ` <br /> 11BO VE-G R CUN O C}^R:STY-30 X <br /> GO W LE rC N C0+4tr'Lc-T1CN <br /> SPECIAL PERMIT INFO. Gird Suiacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) _ ft, <br /> If yes, location and distance - ft. <br /> ft. <br /> �- C <br /> — o <br /> SAMPLING <br /> iocicn — � <br /> Holding Temperature P-IY1;4 Pack <br /> Method b — <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n} <br /> Storage Location Casing type <br /> Blank fr. Screen___.ft. <br /> Slot size <br /> GROUflNG Bags cement <br /> Buckets bentonite_ <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> -installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed vrith geologist: - (y/ n ) <br /> Type of mediod — <br /> EH 29 29 <br />