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%%wUNITORING WELL INSTALLATION RF-P0.,1 <br /> Date: r7 q CONSTRUCITON <br /> Premise Address: Total Depth <br /> Screen Length (from) -- r(to) — <br /> Well No.: Filter Pack (from) (to) - <br /> Bentonite (from) (to)�.� <br /> Inspector: 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: 7- casfnq <br /> Q6 <br /> � he_ght <br /> Consultant Q6 rV` <br /> V —W—f <br /> Geologist AE&E-GRAD <br /> CQfvPLET�ON C>�iiSiY�OX <br /> COMPLEnON <br /> SPECIAL PERMIT INFO. Grourd Swfacs <br /> Distance to sewer line gram <br /> Domestic well on site - (y/ n ) �_.ft. <br /> If yes, location and distance - ft- <br /> SAMPLING 210r6d ;i <br /> socicn � <br /> Holding Temperature :"• <br /> Method <br /> x <br /> Screening Method <br /> Tracking Sheet - {y/ n ) <br /> ft. ir <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> BIank ft. Screen ft. <br /> Slot size <br /> GROLMNG 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 with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />