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OONITORING WELL INSTALLATION REP <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to)�b <br /> Well No.: Filter Pack (from) .i' (to) S <br /> Bentonite (from) (to)� <br /> Inspector: Grout (from) (to) <br /> Drilling rig type_f� S Y <br /> Permit No. Auger O.D. I.D. <br /> Completion Stove p pe/christie box (circle one) <br /> Drilling Company. <br /> Driller: casing <br /> height <br /> Consultant _qED17F <br /> Geologist •- <br /> ��11E NO <br /> COMPL��T10N CHRtS7 4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ft. <br /> Ifes, location and distance - <br /> y ft. <br /> c <br /> o <br /> SAMPLING slottod <br /> saclon '— <br /> Holding Temperature grs„9r pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Z <br /> Blank 10 ft. Screen I S_ <br /> ft• <br /> Slot size 0-11 ;-0 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water t Bags sand/gravel bt CO) <br /> Mix Ratios n•J-&4 Filter Pack type/size Z <br /> Installation Method Surge Block: - �/ n ) <br /> Quantity Installed Discussed with geologist: n ) <br /> Type of method <br /> EH 29 29 <br />