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MONITORING WELL INSTALLATION REk-.�,AT <br /> Date: CONSTRUCTION <br /> Premise Address:_ }_� / _- Total Depth /� <br /> ! Screen Length (from) (to) <br /> Well No.: W Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ae'iO 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: casing <br /> h, height <br /> Consultant C�jn� <br /> Geologist 7, 9 <br /> ABOVE-GROUND CHRIM- ax <br /> COMPLETION COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Seats <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> M <br /> C <br /> 4 <br /> SAMPLING gutted <br /> section <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ft. ft. <br /> SPOILS <br /> Storage Method MATERIALS EVELOPMENT <br /> Contamination Noted - (y/ n ) )-/ft o u <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> tt Slot size <br /> GROUTING W �J Bags cement <br /> ,I i Buckets bentonite <br /> Depth to water 7. 6 3 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 />