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MONITORING WELL INSTALLATION REI <br /> Date: <br /> `I /E M CONSTRUCTION <br /> / <br /> Premise Address: f 5� � 11 l <br /> U., <br /> `Gvy� �l <br /> f 7iq' V 1���n Total Depth 3 3 3 <br /> SUy IZ Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) tbj <br /> Inspector: VJ(5-K)b Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: Zx R <br /> 3 0 z 5 11011 ' casing�� height <br /> SUi� S� <br /> Consultant D S oY <br /> 3 — <br /> � <br /> Geologist $N)Z ABOVF-GROUND <br /> CONFLETICN CHRMTY-Box <br /> CCMPL-ZnCN <br /> SPECIAL PERMIT INFO. Qtnund Satan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) tt <br /> If yes, location and distance - <br /> tt. <br /> — a <br /> = c <br /> _ c <br /> SAMPLING slotted <br /> we <br /> . n - <br /> Holding Temperature - graysi pack <br /> Method —_ <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 /> Wr'Z7;� <br />