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VT-QONITORING WELL INSTALLATION REP <br /> w <br /> Dated ` ''`^ �° CONSTRUCTION `' <br /> Premise Address: Tore! Depth <br /> Screen Length (from) Z S:, <br /> (to) ' <br /> Well No.: Filter Pack (from) .._ I (to) <br /> Bentonite (from) •1 (to) <br /> Inspector: -•_r ' Grout (from ? (to) <br /> — Drilling rig type Mr. f <br /> J, Permit No. Auger O.D. L0 C.D. YT <br /> Completion - Stove pipe/christle box (circle one) <br /> Drilling Company.— <br /> Driller: x `i �. casi <br /> he, t y <br /> Consultant " lis ... <br /> 1 Geologist <br /> ASOVE-GRCOND <br /> CHRM'r' - GOMPLETCN t..mX <br /> COM <br /> c <br /> SPECIAL PERMIT INFO, .•; G=nd Surface.. <br /> .rf Distance to sever line # �' 4rcut <br /> Domestic well on site- (y/n ) <br /> o If yes, location:and distance - ff. <br /> SAMPLING SALT$" slorsi <br /> socicn � 1 <br /> Holding Te peratur . <br /> Method -) A. <br /> Screenin;Nfethod <br /> "s <br /> Tracking Sheet. /n ) <br /> SPOTLS t <br /> Storage Method MATERTALS EVELOPMENT <br /> V+ Contamination Noted - (y/ n ) N <br /> Storage Location u Casing type 7 P V <br /> Blank 20 ft. Screen t :�' <br /> _ Slot size 0.0 3 b <br /> GROUTING Bags cement <br /> _ Buckets bcntonite <br /> Depth to water, 3 1� Bags sand/gravel <br /> G Mix Ratios -._` - Filter Pack type/size X <br /> a Installation Method Surge Block: - { y/01 ) <br /> Quantity Installed Discussed with-geologist: - / n) f <br /> Type of method <br /> EH 29 29 T F <br /> , _ t <br />