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OMONITORING WELL INSTALLATION REOT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller: T height T ight <br /> Consultant <br /> —QV-F <br /> Geologist _ <br /> ABOVE-GACUND <br /> OOMPL--TION GHiIM-BOX <br /> SPECIAL PERMIT INFO. COMPLEnON <br /> Cirwnd Surfap <br /> Distance to sewer line prokR <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> R ft. <br /> m <br /> r <br /> o <br /> SAMPLING — o <br /> slorad <br /> sec�cn <br /> Holding Temperature — <br /> Method = pava pack <br /> Screening Method <br /> Tracking Sheet • (y/ n ) "` — <br /> `:x` _ <br /> ft. = fIe <br /> SPOILS <br /> Storage Method MATERIALS/DEVEI,OPMENT <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 /> EH 29 29 Type of method <br />