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r If P � <br /> MONITORING WELL INSTALLATION PJKP KT <br /> Date: Ulo CONSTRUCTION <br /> Premise Address:.O Oa ` / Total Deprh <br /> Screen Length (from) (to) <br /> Well NO.: Filter Pack (from) (to) <br /> p Bentonite (from) (to) <br /> Inspector. r^ a� Grout Cfrom) Cto) <br /> Drilling rig type <br /> Permit No. Auger O.D. LD. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. =76L <br /> height <br /> Consultant <br /> Geologist ABCVE-GRC(JNC <br /> CCwLZ=N C0wL '- jCX <br /> CCMAI='"C'iCN <br /> SPECIAL PE T INFO. �� Ground � i <br /> grout <br /> Distance to s wer line <br /> Domestic w .1 on site - ( y / n ) RL <br /> if yes, location and distance - t <br /> 3 <br /> SAMPLING <br /> wc'cn <br /> Holding Temperature 71f9I Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) Casing \ 4 <br /> l <br /> Cas <br /> Storage Location Blank '[ fr. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> _ Buckets bentonite <br /> DBags sand/gravel <br /> Depth to water <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block - ( y / n ) <br /> Quantity Installed Discussed with geologist - C y / n ) <br /> Type of method <br /> EH 29 29 <br />