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IONITORING WELL INSTALLATION REF <br /> Date: �r �� CONSTRUCTION <br /> Premise Address: Total Depth 7 6� <br /> �� ��U �� Screen Length (from) .3 (to) 3 3 <br /> Well No.: W Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/chrisrie box (circle one) <br /> Drilling Company: <br /> w�1 casing <br /> Driller: <br /> height <br /> Consultants Lam- T <br /> T <br /> Geologist ��U-��� AE&E-GROUND CHRISTY-BOX <br /> COMPLETION <br /> COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> pram <br /> Distance to sewer line 7 Jca b <br /> Domestic well on site - (y/� L� n• <br /> If yes, location and distance - 3� ft.ft. <br /> = e <br /> slotted <br /> SAMPLING suction _ <br /> Holding Temperature = ViH9I" <br /> ack <br /> Method —_ <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) 3 <br /> ft. ft. <br /> lC <br /> SPOILS <br /> Storage Method /.C � MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ,� <br /> Storage Location 011 /k C Casing type .PVC sr'k 0 <br /> Blank 33 ft. Screen /0 ft. <br /> Slot size . 62- <br /> GROUTING <br /> OZGROUTING Bags cement <br /> Buckets etc <br /> Depth to water 06 Bags sand/gravel <br /> Mix Ratios 702 Zb /b,je, Filter Pack type/sizet5 /C = <br /> Installation Method J� ' Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of method <br />