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MONITORING WELL INSTALLATION REI-%,eT <br /> l <br /> Date: <br /> G % CONSTRUCTION <br /> Premise Address:4361 WTote Depth <br /> - — Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (ro) <br /> Inspector. 9 Grout _ (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/earistie box (circle one) <br /> Drilling Company: <br /> . casing <br /> Driller- <br /> height: <br /> Y 7 T <br /> Consultants _ <br /> N??�TfON C-_AWL^„CN <br /> SPECIAL PERMT INFO. G=nd Sextaes <br /> Distance to sewer line I <br /> Domestic well on site - ( y/ n ) + , <br /> If yes, location and distance - t. <br /> a` <br /> SAMP NG <br /> lic.:cn _ <br /> Holding Temperature t y <br /> Method WWI r <br /> Screening Method 0-I Ig- _ <br /> Tracking Sheet <br /> K- <br /> SPOILS <br /> Storage Metho MATERIALS/DEVELOPNM <br /> Contamination Noted - / n ) <br /> Storage Location Casing type <br /> - Blank fr. Sween f t <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ' 1 Bags sand/gravel <br /> Mix Ratios Filter Pack r}pe/size <br /> Installation Method Surge Block: - C y/ n ) <br /> Quantity Installed Discussed wieh geologist; - (y/ a) <br /> Type of merhod <br /> EH 29 29 <br />