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MONITORIV=INSTALLATIO&RT <br /> Date: �Q CONSTRUCTION n� <br /> Premise Address: ��.x u/m«/l / /�10 sfn�(� �"^ t� Total Depth <br /> Well No.: ( � Screen Length (from) / (to) /77 <br /> Filter Pack (from) h, Y (to) 141 <br /> Bentonite (from) 110 (to) <br /> Inspector: Grout (from) 135 (to) «t <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist 7,7 <br /> ABOVE-GROUND <br /> COMPLETION CHRM-rY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) 05 ft <br /> If yes, location and distance - <br /> `.q O <br /> 0 <br /> O <br /> C <br /> SAMPLING <br /> Slotted — 'c <br /> wc�on - <br /> Holding Temperature <br /> Method <br /> Screening Method — <br /> x <br /> Tracking Sheet - (y/ n) ,z <br /> SPOILS I { <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) r' <br /> Storage Location Casing type <br /> Blank ft. Screen ID ft. <br /> Slot size 0 }� <br /> GROUTING Bags cement <br /> Buckets bentonite 8 <br /> Depth to water Bags sand/gravel I i <br /> Mix Ratios Filter Pack type/size '3 <br /> Installation Method Surge Block: - (0/ n ) <br /> Quantity Installed Discussed with geologist: - (D/ n ) <br /> Type of method <br /> EH 29 29 <br />