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,JIONITORING WELL INSTALLATION REI - -r <br /> Date: �/�O CONSTRUCTION <br /> Premise Address: bJ Q. Total Depth <br /> Screen Length (from) (to) <br /> Well No.: S3 �(0 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> S ROOSS4 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 /> height <br /> Consultant S�lC� LITp <br /> Geologist 5-� � (I)AUf <br /> g <br /> 31, <br /> ABOVE-GROUND <br /> COMPLETION C4iRz1 Y-BOX <br /> SPECIAL PERMIT INFO. Ground Surlact <br /> COMPLETION <br /> Distance to sewer line gr= <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> ft ft. <br /> = m <br /> O <br /> C <br /> SAMPLING 5 slotted <br /> pc" <br /> Holding Temperature <br /> Method �"� ` <br /> Screening Metho <br /> Tracking Sheet - (y/ n ) — <br /> SPOILS <br /> Storage Method MATERIALS EVELOP NT 6,0d�4� <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 3 z— Bags sand/grave <br /> Mix Ratios /►tiL Filter Pack type size <br /> Installation Method Surge Block: - y/ n ) <br /> Quantity Installed Discussed wi geologist: - ( y/ n ) <br /> Type of metlybd <br /> EH 29 29 <br />