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SNITORING WELL INSTALLATION REPO* <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)—(to)- <br /> Well <br /> from) (to)Well No.: Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> height <br /> Consultant <br /> T— —w <br /> Geologist - T <br /> ABOVE-GACUND CHAtSTY BOX <br /> COMPLETION COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Surlacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) tt, <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING .tonoi <br /> on — <br /> Holding Temperature <br /> V&VW Pack <br /> Method = <br /> Screening Method r <br /> Tracking Sheet - (y/ n ) x; <br /> tt. = tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fr. 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 />