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/J MONITORING WELL INSTALLATION RF-PGni <br /> I ,y�• �' ����(//,�p���-�. `tel/`ice fit/-/` <br /> Date: A CONSTRUCTION <br /> Premise Address: �-Q YZA_*4 r Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �,� a Grout (from) (to) <br /> 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 /> XLI <br /> Consultant o '4 \ <br /> Geologist ._ T <br /> ABCVE-GACUND CHRZ Y43OX <br /> CONFLETCN CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> w <br /> SAMPLING _ <br /> iacicn <br /> Holding Temperature = gnVW Pack <br /> Method '- <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) r. _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <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 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />