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- MONITORING WELL INST ALJ ATION RE. ._XT <br /> t6-19 0� <br /> Date: � CONSTRUCTION t <br /> �y� 0 !C)c[ r2 oP t 20"10 13 3 l <br /> Premise Address: Total Depth 1 <br /> Screen Length (from) (to) <br /> Well No.: LtJ /�; [�,/ZI - Filter Pack (from) (to} i <br /> Bentonite (from) (to) <br /> Inspector: Gd'� _- Grout (from) (to) <br /> Drilling rig e <br /> Permit No. Auger O.D. _ LD. <br /> Drilling Company: <br /> 11 Completion- Stove pipe/christie box (circle one) <br /> Driller: Casing <br /> height <br /> Consultant <br /> Geologist .r 1 <br /> AWVE-GROUND <br /> t oowLETIGNC-HRMTYLE-8DX <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n} ft.If yes, location and distance - <br /> ft. <br /> SAMPLING <br /> slotted : <br /> Holding Temperature <br /> Method �" Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> _tL ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type 's P*1 <br /> Blank. ft. Screen ft. <br /> Slot size 0,02.0 <br /> GROUTING Bags cement <br /> ( Buckets bentonite <br /> Depth to water .� A F> I J Bags sand/gravel <br /> Mix Ratios Filter Pack typesize _ <br /> Installation Method 2L6=iAz Surge Block: -®/n ] <br /> Quantity Installed Discussed with geologist: - G/ n ] <br /> Type of method <br /> EH 29 29 <br />