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MONITORING WELL INSTALLATION REI-.,j&T <br /> Date: CONSTRUCTION <br /> Premise Address: JOU 6d ZZW z0h R Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> `� Bentonite (from) (to) <br /> inspector �/1' Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. [.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � L`'� <br /> Driller. Cas ing <br /> he:gYir. <br /> Consultant <br /> Geologist <br /> ASCUS-GROUND q-RLS�^C-¢OX <br /> CCPVF R'AN CCMPI=�,CN <br /> SPECIAL PERMIT INFO. Ground SLrf'" J <br /> '0 <br /> Distance to sewer line J <br /> Domestic well on site - ( y/ n ) # `t. <br /> [f yes, location and distance - <br /> 9 <br /> MPI ING ticm*d <br /> Sr� <br /> 6YG.:CR <br /> Holding Temperature _ — 72vol <br /> Method <br /> Screening Method <br /> -Cracking Sheet - C y/ a } <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPN ENT <br /> Contamination Noted - C y/ n } Casing type <br /> Storage location Blank ft- Screen � <br /> Slot size <br /> GROUTING 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: - C Y <br /> Type of method <br /> EH 29 29 <br />