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r, `el <br /> MONITORING WELL INSTALLATION REP-Kr <br /> ^` <br /> CONSTRUC <br /> `D: /t�f1�I p TION <br /> U -7'1���6J, �( Toral Depth. ( �I�r <br /> Premise Address: <br /> e Screen Length (from) - (to) <br /> Well No.: / / /��� � nz C /'1t� Filter Pack (from) --,c <br /> / Bentonite (from) 1 (to)�' 1 _ <br /> Grout (h�S [ (to <br /> Inspector ) , i�. ��-t.•a <br /> f Ding rig type, <br /> Permit No. Auger O.D. ,t t I.D. ' <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> l� casing <br /> Driller. height <br /> r � ► <br /> Consultant <br /> Geologist .t <br /> e2: /I,gCVE-C,RCUND q..A�vgpX <br /> C~ivP!�T'ON C�{ript=iiCN <br /> Ground Sisfscs <br /> SPECIAL PERMIT INFO. <br /> PR grout <br /> Distance to sewer line 2 ' <br /> Domestic well on site - ( y/ n ) ------ • <br /> If yes, location and distance - <br /> 3 <br /> — � o <br /> _ _ o <br /> � = o <br /> SAMPLING •tottae _ <br /> wc:cn <br /> Holding Tem eratu�eAl <br /> Method �L <br /> Screening Method _ _ <br /> Tracking Sheet - Cy/ n ) _ <br /> lilt_ <br /> /rl,, <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - �y�/i `l t,1 v�� ;cj_14 C' <br /> Casing type ft <br /> Storage Location Blank ft. Screen <br /> Slot size -� <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> �3� Bags sand/gravel <br /> Depth to water <br /> �a � Filter Pack type/ a -Z_ <br /> Mix Ratios Surge Block: - y n ) <br /> Installation Methods S <br /> uand Installed �� Discussed with eulogist: - (� n} <br /> Q ty Type of method <br /> EH 29 29 <br />