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• MONITORING WELL INSTALLATION RORT <br /> Date: 9 1 2.3 W CONSTRUCTION <br /> Premise Address: 03Zn�pok Total Depth <br /> ' Screen Length (from) (to) <br /> Well No.: W I Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: C 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: K/, casing YtT heightConsultant Si <br /> VM— <br /> Geologist I T <br /> ABOVE-GROUND CNAI5TY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. around Ste"° <br /> proof <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) 70 ft. <br /> If yes, location and distance - .�1, y ft. <br /> V ft. <br /> = m <br /> p <br /> O <br /> C <br /> O <br /> SAMPLING slottodon <br /> = ` <br /> Holding Temperature �S _ 911W Pack <br /> Method <br /> Screening Method �b <br /> Tracking Sheet - (y/n ) p; _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) g <br /> Storage Location Casing typed PSC <br /> Blank ft. Screen ft• <br /> Slot size 67— <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ti�` Bags sand/gravel <br /> Mix Ratios n n , L Filter Pack type/size 3 <br /> Installationethod�� Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />