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MONITORING WELL INSTALLATIO*PORT <br /> Date:�� � CONSTRUCTION <br /> Total Depth qPremise Address: <br /> M ) Screen Length (from) q0 (to) <br /> Well No.: �'1/ /-� Filter Pack (from) tY (to) 8 L <br /> Bentonite (from)8b (to) 71�— <br /> Inspector: �(�1" —� Grout (from) Y0 (to) <br /> Drilling rig type <br /> Permit No. <br /> Auger O.D. I.D. <br /> / <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant T <br /> Geologist AE&E-GROUND <br /> CC N!P LEf IO N COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground Surixs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ' ft. <br /> If yes, location and distance - 9,/ ft. <br /> C <br /> O <br /> SAMPLING slottec2 <br /> spcaon <br /> Holding Temperature = P <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) n <br /> Casing type J NC/ <br /> Storage Location <br /> Blank_ ft. Screen ft <br /> Slot size <br /> GROUTING Bags cement �3 <br /> Buckets bentonite <br /> Depth to water Y L' Bags sand/gravel 2- <br /> 00 <br /> Mix Ratiosg,, � Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) i <br /> Quantity Installed Discussed with geologist: - (�jy/ n ) <br /> Type of method <br /> EH 29 29 <br />