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MONITORING WELL INSIALLAPet/11L LtT <br /> r <br /> C <br /> Date : <br /> z1yd,ol CONSTRUCTION <br /> Premise Address : �66 �' T�Itiwtn Total Depth <br /> Screen Length (from) (to) <br /> Well No. 416✓ Filter Pack (from) (to) <br /> L� �) ,�// Bentonite (fro (to) <br /> Inspector: ry`yGrout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I .D. <br /> Completion - Stoyepipchr stie box (circle one) <br /> Drilling Company: <br /> Driller: T casing <br /> ^ T height <br /> Consultant <br /> ABOVE-GROUND CHFiISTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlace <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - It, <br /> ff. <br /> h. <br /> 7a <br /> SAMPLINGalattad <br /> sac5on - <br /> Holding Temperature <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) N nU <br /> Storage Location Casing type 1 <br /> Blank ft. Screen ft. <br /> Slot size <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 /> it <br />