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MONITORING WELL INSTALLATION REP# <br /> Date:_ J2Z /�� CONSTRUCTION <br /> Premise Address: L Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: 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 ILT <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION CHR STY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Stataos <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) �—ft <br /> If yes, location and distance - <br /> _ft ft. <br /> O <br /> O <br /> r <br /> c <br /> SAMPLING slotted <br /> Section — <br /> Holding Temperature <br /> Method — g"y9l Pack <br /> Screening Method <br /> Nt <br /> Tracking Sheet - (y/ n ) <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 typesize <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />