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MONITORING WELL INSTALLATION R` IT <br /> Date: -(� CONSTRUCTION�Q, <br /> Premise Address: 3 <br /> � �� Total Depth <br /> Screen Length (from) .39 (to) l6 <br /> Well No.: Filter Pack (from) 3$ (to) 17 <br /> Bentonite (from) 17 (to) 15 <br /> Inspector: Grout (from) ! (to) o <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. S h <br /> Completio -...Stove p' a/chrisrie box (circle one) <br /> Drilling Company: <br /> casin �� <br /> Driller: T_ heigh 2- <br /> Consultant T <br /> T <br /> Geologist C��! -*-� �180VE-GROUND <br /> � CHRISTI'-80X <br /> COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line O <br /> Domestic well on site - (y/0 I n• <br /> If yes, location and distance - 1 �• <br /> 1p <br /> slotted <br /> SAMPLING &scion <br /> Holding Temperature 1. A— _= ;myw Pack <br /> Method <br /> Screening Method PC _ <br /> Tracking Sheet - n ) 3 <br /> SPOILS ' J <br /> Storage Method C V MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/9 <br /> Storage Location rj;k- 5i� Casing type <br /> Blank h. Screen <br /> Slot size •b 1 <br /> GROUTING Bags cement <br /> Buckets bentonite 2 ' <br /> Depth to water 26- Z? Bagssand/gravel 1? �`U r S <br /> Mix Ratios / 1? 4- `�- _51d Filter Pack type/size l2 LS <br /> Installation Method Surge Block: - Y n ) <br /> Quantity Installed du Discussed with geologist: - / n ) <br /> Type of method ACZ_16 et - A <br />