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MONITORING WELL INSTALLATION REPeI-P.T <br /> Date: / 3/O CONSTRUCTION <br /> Premise Address: dor /I e Total Depth <br /> Screen Length (from) (to) <br /> Well No.: _ .3 Filter Pack (from) (to) <br /> l Bentonite (from) (to) <br /> Inspector: ¢ t2i Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/-Tu istie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> 661 height <br /> Con��#lta�� <br /> Geol ' t IRK <br /> ABOVE-GROUND <br /> COMPLETION CtiR15' X <br /> COMPLLETIOEnO N <br /> SPECIAL PERMIT INFO. Ground Surta" •• <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/n) f <br /> If yes, location and distance - n. <br /> w. <br /> SAMPLING = <br /> slotted = c <br /> soon <br /> Holding Temperature <br /> ack <br /> Method 'J I&V P <br /> �; <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 <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 />