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MONITORING WELL INSTALLATION M-.,AT <br /> . 4 <br /> Date: �L D1' + CONSTRUCTION' <br /> Premise Address: Total Depth <br /> nnA <br /> Screen Length (from) (to)T_ <br /> Well No`.: A w Filter Pack (from) -(to) <br /> P `�� Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> � � � �,a Gyqq Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist , <br /> Ai&E-GROUND <br /> COMPLETION CHRIS'TY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n- <br /> _1.i`tt. it. <br /> � m <br /> Cr <br /> SAMPLING slotted c <br /> section <br /> Holding Tgmperagravel tu� L = P <br /> ack <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method /� � \�'�I MATERIALS/DEVELOPMENT <br /> Contamination No d - y/ n ) <br /> Storage Location t_ , A&j 1 Casing type 3' �✓y' S �d <br /> J Blank ft. Screen ft. <br /> Slot size 0.024 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to wate 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 />