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OONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector:p Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: Ttl height <br /> Consultant <br /> --7m —WW–f <br /> Geologist ABCVE•GROUND CHRL,,SoX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. ��� nd 8urlact 7 — <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) n. <br /> If yes, location and distance - n <br /> n. <br /> = a <br /> = m <br /> — d <br /> c <br /> — o <br /> SAMPLING slotted = S <br /> wo5on <br /> Holding Temperature gm1w Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (Y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS�EVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft. Screen-----------ft. <br /> Slot size <br /> GROUTING - Bags cement <br /> j. Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Filter Pack type/size <br /> Mix Ratios <br /> ISurge Block: - (y/ n <br /> Installation Method ) <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br />