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MONITORING WELL INSTALLATION REI-• <br /> Date: �lZa l(/ y� CONSTRUCTION2 s <br /> Premise Address: Total Depth U <br /> S S 3 <br /> Screen Length (from) <br /> GSJ /a n(to <br /> Well No.: Z. / 1 OX Filter Pack (from), <br /> Bentonite (from) (to) <br /> Inspector: WHN 2 SjGrout (from) (to)— <br /> Drill g <br /> to)Drilling rig type <br /> Permit No. o�fAuger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: j a <br /> Driller: ' casing <br /> height <br /> Consultant <br /> M ff-- -Z W-f <br /> Geologist <br /> ABOVEGROUND CHAWY$OX <br /> OOMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - Vim, <br /> a <br /> SAMPLING Warod _ c <br /> aecton S <br /> Holding Temperature - WzM pack <br /> Method _ Lft._ <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 /> 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 />