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1 <br /> MONITORING WELL INSTALLATION RET <br /> Date: CONSTRUCTION <br /> CONSTRUCTION <br /> Premise Address: Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: e52re� ��� �'' L Filter Pack (from) (t <br /> Bentonite (from)-( ) <br /> Inspector: CLC ^ 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. TffLT <br /> height casing <br /> 1 <br /> Consultant 6�U✓I 4 (�! r <br /> Geologist C3� - T <br /> ABOVE-GROUND CHRZI Y-BOX <br /> OOMPLE7bN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sul <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) tt <br /> If yes, location and distance - <br /> tt. <br /> a <br /> J C <br /> SAMPLING storied <br /> / aocton <br /> Holding Temperature Y <br /> Method = <br /> Screening Method ' <br /> Tracking Sheet - (y/ n ) <br /> SPOILS �< <br /> Storage Metho4l MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank 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 wi geologist: - ( y/ n ) <br /> Type of me od <br /> EH 29 29 <br />