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MONITORING WELL INSTALLATION ART <br /> Date: 4/ t' Dp' / / CONSTRUCTION <br /> t <br /> Premise Address: 3?C , Jt-(;"E, a., ' Total Depth l I il' <br /> _ Screen Length (from) (to) <br /> Well No.: CPT ( - C07-S Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: n � 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 ACS T <br /> Geologist 7:;r a - T <br /> ABOVEGROUND CHRIS7Y-BOX <br /> COt.�L ETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAacs <br /> Distance to sewer line oar gf0ut <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - tt. <br /> ft. <br /> n. <br /> = m <br /> P <br /> O <br /> C <br /> SAMPLING SIOitGd _ B <br /> sac5on —_ <br /> Holding Temperature el`(I <br /> Method (11)A _ Pack <br /> Screening Method r�P/ � <br /> tl <br /> i/ = — <br /> Tracking Sheet - n ) <br /> SPOILS �v wad <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type Gr�r <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 'vZ0 17 Sb Bags sand/gravel <br /> Mix Ratios n.c c 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 />