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MONITORING WELL INSTALLATION RL ;.T <br /> 31Ve) <br /> Date: I CONSTRUCTION <br /> Premise Address: / °L _' Total Depth <br /> Screen Length (from) - 5 (to) to <br /> Well No.: y �/ w Filter Pack (from) i -I (to) <br /> Bentonite (from), (to) <br /> Inspector. Grout (from) (to) -j I <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: casing <br /> T height <br /> Consultant f'u- <br /> IV —qVTQ7//, <br /> Geologist -- <br /> AE 0V -GRC(JND CNRISTY-8oX <br /> COM LEE-7 CN COMPLEnCN <br /> SPECIAL PERMIT INFO. Caroun <br /> , � <br /> I d Suri <br /> act <br /> �rout <br /> Distance to sewer line J <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - r. ft. <br /> q <br /> C <br /> SAMPLING •lora.! _ <br /> soden <br /> Holding Temperature = V'„W <br /> Pack <br /> Method <br /> Screening Method :r <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) ' C� <br /> Storage Location Casing ty <br /> Blank ft. Screen I S' ft. <br /> Slot size (�r n P <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method 2.1 i„ti / Surge Block: - ( y/ n ) <br /> Quantity Installed < Y Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />