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� 3 <br /> .40NITORING WELL INSTALLATION M _._f <br /> Date: <br /> Premise Address: 2�y 3� Total Depth <br /> � Screen Length (from) (to) <br /> / <br /> Well No.: C�t9Ae&J--- Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: gkla-" 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: casing <br /> e height <br /> Consultant <br /> Geologist ('�-e cclo- <br /> Aso -GROUND <br /> OOMPLETION COMPLEnCN <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> ft. ft. <br /> SAMPLING � <br /> E <br /> slotted : <br /> — <br /> sacaon — <br /> Holding Temperature <br /> Method ) = P <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) ^ — <br /> :X M <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 />