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k <br /> L <br /> ^ MONITORING WELL INSTALLATION RE OP FLT <br /> Date: OC CONSTRUCTION <br /> Premise Address: 2� <br /> Total Depth <br /> Well No.: Screen Length (from) (to) . <br /> Filter Pack (from) (to)~- <br /> Inspector: �"* - Bentonite (from) (to) <br /> i Grout (fr m) [to) <br /> Permit No: - M Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling,Company: Completion - Stove pip Christie box [circle one) <br /> Driller: <br /> casing <br /> Q height <br /> Co�Itant 4�[ ,�fi.E'!. <br /> Geologist <br /> x 7F <br /> A84YE-GROUND <br /> { COMPLETION fSTY-SOX <br /> SPECIAL PERMIT INFO C PLETION <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - T n <br /> s "ft. ft. <br /> j�• ''+� m <br /> - Y <br /> SAMPLING r. o <br /> .. slotted :: c <br /> sac71on $ <br /> Holding Tqmperetwe <br /> Method M L- <br /> Screening Method «s <br /> Tracking Sleet -' / n ) — <br /> :;: <br /> SPOILS <br /> Storage Method MATERIALS EVEL PMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location ; Casing type ` <br /> 5 <br /> _s Blank' ftA Screen {t, <br /> Slot size <br /> GROUTING Bags cement <br /> l! Buckets bentonite <br /> Depth to water f�,. T�� bf _ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size -k <br /> Installation Method F Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - [y/ n <br /> EH 29 <br /> Type of method <br /> 29 <br /> , <br />