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\.,O!-)NITORING WELL INSTALLATION REIN'—' <br /> Date: J /O;/I I CONSTRUCTION <br /> Premise Address: ��7 �`� �` /`�-i'� '��� Total Depth <br /> "J! Screen Length (from) D (to) <br /> Well No.: t S� Filter Pack (from) �f b (to) <br /> //� <br /> ` Bentonite (from) f� (to) l �_ <br /> Inspector: /J Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> I F, height <br /> Consultant <br /> Geologist -- <br /> ABOVE-GACUND CHMM-BOX <br /> COWLE?ION COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surfaces <br /> Distance to sewer line AA,w 2 M u w grout ro <br /> Domestic well on site - (y/n ) M w & ft. <br /> If yes, location and distance <br /> 20 Z dv eft. <br /> SAMPLING •lored = <br /> socdcn <br /> Holding T mper�e <br /> Method aM lea _ Pack <br /> Screening Method P-LD — <br /> Tracking Sheet n) :;;` <br /> o 2 �b 4 lip g-p n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) J� <br /> Storage Location Casing type <br /> Blank 710 ft. Screen <br /> Slot sizeU-D ' <br /> GROUTING Bags cement <br /> 't'- Buckets bentonite- <br /> Depth <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method 1 eA4 g. Surge Block: - (y/C)) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />