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,MONITORING WELL INSTALLATION REP(_-.., <br /> Date: 7/ �l ____..__. CONSTRUCTION <br /> Premise Address: Total Depth S <br /> Screen Length (from) VS f- (to) <br /> Well No.: Filter Pack (from) IS (to)� <br /> Bentonite (from) tf (to) 3 <br /> Inspector: Grout (from) ; -(to)� <br /> Drilling rig type <br /> Permit No. Auger O.D. all <br /> I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> TVheight <br /> Consultant T <br /> Geologist •- T <br /> ABOVE-GROUND CHRLM43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. [hound Surface <br /> Distance to sewer line Qf°tA <br /> Domestic well on site - (y/ n ) 2 3 <br /> • <br /> If yes, location and distance - <br /> I 5 ft. ft. <br /> b <br /> C <br /> SAMPLING Maros <br /> slotted � <br /> sac9on <br /> Holding Temperature Vi„el pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/"n <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 2 p PU C' <br /> Storage Location Casing type <br /> Blank 5 ft. Screen 16 ft. <br /> Slot size o,o I b <br /> GROUTING , Bags cement <br /> Sr. Buckets bentonite a-S <br /> Depth to water Bags sand/gravel S <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n } <br /> Quantity Installed Discussed with geologist: - ray / n ) <br /> Type of method <br /> EH 29 29 <br />