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MONITORING WELL INSTALLATION 'ORT <br /> Date: 7 � <br /> CONSTRUCTION <br /> Premise Address:_Q2 /0 / <br /> Total Depth <br /> u� Screen Length (from) (to) <br /> Wel] No.: Filter Pack (from) S (to) 2�_ <br /> Bentonite (from) 3 (to) <br /> Inspector: Grout (from) (to) A <br /> f Drilling rig t3e, <br /> Permit No. _ �p Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> Consultantj <br /> 6� height <br /> Geologist_�d'�^ / .. T <br /> A80YE-GROUND <br /> COMPLETION CHRIVY4= <br /> COMPLETION ' <br /> SPECIAL PERMIT INFO. I Ground Suriacs <br /> Distance to sewer line (�- Grp <br /> Domestic well on site - (y <br /> if yes, location and distance - Z <br /> Ott. ft. <br /> a�• p <br /> J..a+• C <br /> SAMPLING sbttvd '— <br /> p sacdon •�'• — <br /> Holding Temperature <br /> Method CL _ V'VW Pack <br /> Screening Met6d PIP <br /> Tracking Sheet - 01 <br /> n ) <br /> _ft. <br /> SPOILS �IT) <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location - Casing type O ! �� <br /> Blank__Z_ ft. Screen LU ft• <br /> Slot size <br /> GROUTING Bags cement 9/'/-7 <br /> Buckets bentonite /J-D <br /> Depth to water 4 8 Bags sand/gravel l <br /> Mix Ratios /tA Q Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n <br /> Quantity Installed + Discussed with geologist: - / n ) <br /> Type of method <br /> EH 29 29 <br /> 9A ,�� <br />