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140NITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION [ r <br /> Premise Address: - <br /> () - Total Depth !? <br /> Screen Length (from) (to) <br /> Well No.: 7 Filter Pack (from) (to) <br /> j Bentonite (from) (to) <br /> Inspector: 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: 1����'' casing <br /> height <br /> Consultant T <br /> T <br /> Geologist Ai&E-GROUND <br /> COMPLETION CHRMTY43OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. }� Ground Surface <br /> I � grout <br /> Distance to sewer line �, C <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> 2� ,V ft' <br /> SAMPLING BIGttad <br /> Bacton _ <br /> Holding Temp ature = gni Pack <br /> Method <br /> Screening Method_ _ <br /> Tracking Sheet / n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Bl� ft. Screen frt• <br /> Slot size t>sO 7— <br /> GROUTING <br /> -GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ��DC7 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 /> e of method <br /> ^`7 <br /> EH 29 29 <br />