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r MONITORING WELL INSTALLATION Ra-. T <br /> CONSTRUCTION J <br /> Date: I <br /> � Total Depth (to) <br /> premise Address: Steen Length (from) (to) <br /> f Filter Pack (from) <br /> Well No.: Bentonite (from) ta) <br /> n ' �I�I Grout (from)ia (to) <br /> Inspector. 'N l Drilling ng type <br /> Auger O.D. I.D. <br /> Permit No. J Completion - Stove pipe/Christie box (circle one) <br /> Zk <br /> Drilling COmDan9 Ia <br /> casing <br /> Driller.---,� en/V� F height i <br /> Consultant 7Q <br /> A `4Epi - + ♦ <br /> Geologist AgCVE-.9AWN0 pHSM;!-3CX <br /> CC}„Ft_T'AN C;CMpt.EriCN <br /> -T---- <br /> SPECIAL PERMIT INFO- <br /> Distance <br /> E05-0 Distance to sewer lineDomestic wet on site - n e n ) Sa-d fL <br /> [f yes, location and distance - d <br /> SAMPLING <br /> pack <br /> Holding Temperature _ I <br /> Method <br /> Screening Method I = <br /> Tracking Sheet • (y/ n) �`Q /bs ' S l�� K ♦ _ ♦ —tt <br /> SPOILS <br /> MATERIAIS/DEVELOPIvfENT <br /> Storage Method 0 <br /> Contamination ored - (y/ n) Casing type <br /> Storage Location Blank _ft. Screen-- — <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonire <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Bloch: - (y/ n ) <br /> Installation Method Discussed with geologist: C y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 P#— <br />