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f <br /> `MONITORING WELL INSTALLATION <br /> Date: <br /> /�, �l - CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)Well No.: V V " .� Filter Pack (from) (to). <br /> �� `� Bentonite (from) (to) <br /> Inspector: `7L Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> i Completion -Stove pipe/christie bog (circle one) <br /> Drilling Company: <br /> Driller: `> MUI�Z casing . <br /> IT heigh <br /> Consultant f �6Y1�r�( —WWT <br /> Geologist �trAs ABOVE-GROUND <br /> CO&FLEr[ON CiiCpPLE-MPLc''TICN <br /> SPECIAL PERMIT INFO. G=rd S <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> c <br /> (O rrp ; o <br /> SAMPLING slod ` <br /> Holding Temperature vr1 _ 9MV91 Pack <br /> Method — <br /> Screening Method —_ <br /> Tracking Sheet - (y/ n ) �� cf-) :. <br /> / !t. <br /> SPOILS d U <br /> sok <br /> Storage Method MATERIALS EVEI'OPMENTC <br /> Contamination Noted - (y/ n ) q> J <br /> Storage Location Casing type <br /> Blank f- Screen--------ft- <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: - (y/ n) <br /> Type of method <br /> EH 29 29 / <br /> Fro <br /> VSs CS�-S � 'f <br />