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.iONITORING WELL INSTALLATION REPO <br /> Date: 142 CONSTRUCTION <br /> Premise Address: IY � 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 /> m� <br /> ` <br /> Driller• ` . S{ - -U<— _ casing <br /> � height <br /> Consultant—i_/'T � � ____ <br /> Geologist <br /> ABOVE-GRCX JND CHRtSTY BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n <br /> If yes, location and distance - . <br /> p <br /> C <br /> Q <br /> SAMPLING slotted C <br /> secdon <br /> Holding Temperature ';. gm„W pack <br /> Method _ <br /> N <br /> Screening Method ' = <br /> Tracking Sheet - ( y/ n) : . <br /> SPOILS <br /> Storage Method MATERIALE12EVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> �j Buckets bentonite <br /> Depth to water 7 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 />