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A <br /> P <br /> MONITORING WELL_INSTAI,T.ATIONR1r <br /> y i � YCONUtChTTON <br /> Date <br /> Premise Address: i Total Depc �' <br /> ~� <br /> - <br /> Screen Length (from)_ (to) <br /> Well No.: - , Filter.Pack , (from) (to) , <br /> Bentonite (from) - —(to) <br /> Inspector:.. E 3 Grout (from) - (to) <br /> Drilling rig type <br /> --Permit No. _ _ ` -Auger O.D. 'A.D <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company-... <br /> Driller: '�. _ `',r casing <br /> height , <br /> Consultant.. _ _ ., IV <br /> Geologist <br /> A80VE-GFiCUN!] CITY-BOX <br /> COMPLETION _ COMPLEEMON --j <br /> EPECTAL PERMIT:INFO. G=nd Sw•Tacs <br /> 41 orcut <br /> Distance to sewer line - <br /> Domestic well'on site - (y/n)` .,,..:.,f• <br /> If-yes, location and distance - `« - <br /> f • r _ c. <br /> W ' <br /> SAMPLING : s• +' ' :" slor.a.i <br /> ... y n _- .. • . .�. soc cn <br /> „ HoIding Temperature " = ,� <br /> Iack <br /> d .. �.. , _ f is �' F <br /> Method. <br /> a <br /> 1 + .Screening Method _ _ _ — IN i x <br /> r i Tracking Shcet - ( y/ n) <br /> t <br /> . SPOILS - •- I <br /> S{ k <br /> 1 i ` 4I <br /> Storage Method , MATERIALS(DI:VEI.OPMENT _ <br /> 'Contamination Noted - (y/n ) ,� <br /> Storage Location = _ _ Casing type `" <br /> Blank ft Screen ft. , <br /> Slot size <br /> 1 GROUTING Bags cement <br /> ., - ry ,a .,; Buckets bentonite <br /> Depth to water k Bags sand/gravel <br /> •Mix Ratios - Filter.Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> i Quantity Installed = -Discussed with geologist: - ( y/ n) <br /> fType of method ` <br /> EH 29 29 <br /> IN <br /> ;; <br />