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r.: <br /> MONITORING WELL INSTALLATION RkP-rj"RT <br /> Dated CONSTRUCTION <br /> Premise Address: �P�S „� -,r� Total Depth v r <br /> d Screen Length (from) (to) <br /> Well No.: N CP r no— Finer Pack (from) (to) <br /> r � � Bentonite (from) 2 (to) -1 5 <br /> Inspector: !� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> '���,nsC��� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Ca <br /> Driller: 0 P, casing <br /> height <br /> Consuliant�_ � <br /> V <br /> Geologist IJ::� <br /> ABOVE-GRCUND CHMM-BOX <br /> CCMPL.ETION WMALEEMN <br /> SPECIAL„PERMIT INFO. Ground Susan <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n) .-ft. <br /> If yes, location and distance - fs- <br /> ft. <br /> V <br /> 4r. r <br /> fes: Q <br /> SAMPLING <br /> soden — <br /> Holding Temperature <br /> Method ' 94W Pack <br /> Screening Method — <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> ---- <br /> Blank ft. Screen ft. <br /> Slot size O <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 />