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.AONITORING WELL INSTALLATION REPS <br /> Date: CONSTRUCTION <br /> 3-� ! -� <br /> Premise Address: dory ' �� 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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: height casing <br /> Consultant —QW7;F <br /> 7 I'd <br /> Geologist •- <br /> ABOVE-GROUND CHRZ Y43OX <br /> f COMPLETION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Groub Su dwe <br /> Distance to sewer line grout <br /> Domestic well on site - (y!n ) n. <br /> If yes, location and distance - <br /> _ a <br /> SAMPLING slotted <br /> sec;;on �> _ <br /> Holding Temperature = gm„vl pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> -ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <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 /> Type of method <br /> EH 29 29 <br />