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MONITORING WELL INSTALLATION RIn--e-T <br /> Date: CONSTRUCTION <br /> ?remise Address:... Lv ' r�c-c `r1x��`'`�'t^'_ h�`� Total Depth <br /> Seen Length (from) (to) <br /> Well No.: <br /> 1 V . l Filter Pa`k (from) (to) <br /> Bentonite (from) (to) <br /> `i <br /> inspector .1 Grout (from) (to) <br /> . �'. <br /> Drilling rig type <br /> Permit No. Auger O.D. E.D. <br /> Completion - Stove pipe/carisrie box (circle one) <br /> Drilling Company: <br /> Tcasing <br /> Driller: T height <br /> Consultant <br /> A�L� <br /> C' SCVD-GROtJIVD <br /> CC&F CET;ON <br /> COhiRL� CN <br /> SPECIAL PERMIT INFO. G`cuM SLe"' <br /> K <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - C y <br /> if yes, location and distance - t. <br /> a <br /> SAMPi.ING -tad y <br /> .- <br /> ♦QC.Cn _ <br /> Holding Temperature — 7XV1W iack <br /> Method <br /> Screening Method " — <br /> Wracking Sheet - C y/ n ) <br /> ;t. ♦ n <br /> SPOILS <br /> Storage Method MA-IERIALS/DEVELOPN ENT <br /> Conraminadon Noted - (y/ n ) �/� t'6/C.i <br /> Storage Location Casing ryPe <br /> gl fc Screen <br /> Slot size <br /> GR,O—tMNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Enstaliation Method Surge Block. - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n} <br /> Type of method <br /> EH 29 29 <br />