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MONITORING WELL INSTALLATION REIT-e-r <br /> zoo 1 CONSTRUCTION <br /> Date: <br /> LO s Total Depth <br /> Premise Address: y �s <br /> Screen Length (from) �Z__Cto) � <br /> / �� — Filter Pack (from) <br /> Well No.: Bentonite (from) 33 (to) <br /> v01 Grout (from) 3 (to) C7 <br /> inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Sto pipe/chrurie box (circle one) <br /> Drilling Company: 3K <br /> casing <br /> Driller. 7F he 4-9 <br /> ♦ 7 <br /> Consultant <br /> ��Geologist U 1 ABCYE-GRCUND c8sts-,Y-8CX <br /> OCNF!°TON CI—AVL=—,ICN <br /> ck=rld Surf <br /> SPECIAL PERMIT INFO. CSIttWQy , <br /> Mw I - ►1v�3 y 4f«n <br /> Distance to sewer line �- <br /> Domestic well on site - ( y/ n ) <br /> if yes, location and distance - -- - <br /> SAMPLING ,,I //,.�1e5,�,1,� locwd _ a <br /> o OC.Yo �q'�S <br /> 7"Pack <br /> Holding Terx}plerature ' — o►' � '-: __ <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n) <br /> SPOILST'P <br /> Storage Method '' RIAI-S/D�LOPII�NT <br /> � � � <br /> Contamination Noted �/ n) <br /> Storage Locarion rng ryPe fL <br /> �� Bl ft. S ,een = <br /> size C-11 Z 0 — <br /> 5'A Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water <br /> Filter Pack typesize <br /> Mix Ratios Surge Block: - (y � <br /> installation Method Discussed with geo gist ' qy'/J n) <br /> Quantity Installed Type of method lam/ <br /> EH 29 29CdA6VYV- <br /> ya- <br />