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MONITORING WELL INSTALLATION REPO <br /> Date: �� CONSTRUCTION <br /> Premise Address: �� S CAAe)40 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> 9 Bentonite (from)-(to)- <br /> Inspector: <br /> from) (to)Inspector: G`/, � Grout (from)-(to)- <br /> Drilling <br /> from) (to)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 /> height <br /> Consultant IV <br /> . T <br /> Geologist - T <br /> ABOVE-GACUND CNAtSTY BOX <br /> COMPLETION COMPLEMON <br /> SPECIAL PERMIT INFO. Ground Surlacy <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft- <br /> it. _ <br /> N�. <br /> O <br /> f'. O <br /> SAMPLING = g <br /> doCnd Z <br /> sacicn <br /> Holding Temperature <br /> Method ;! _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) I7: <br /> tt. = ft. <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 />