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�NITORING 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 <br /> from) (to)Bentonite (from)—(to)- <br /> Inspector- <br /> from) (to)InspectorGrout (from)-(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-isde box (circle one) <br /> Drilling Company: <br /> Driller. r casing <br /> T height <br /> Consultant T' <br /> T <br /> Geologist <br /> A8CVS-GACUND C SLSTY-aOx <br /> CCAf 1"—TCN CCMPL__rCN <br /> SPECIAL PERMIT INFO. 3=nd Suiacs <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) �_ ft. <br /> If yes, location and distance - ft. <br /> —ft. <br /> a <br /> SAMPLING brad - c <br /> sac.cn <br /> Holding Temperature _ Lsava adt <br /> Method = <br /> Screening Method 5 <br /> Tracking Sheet - ( y/ a) <br /> t = t tL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing We <br /> Blank fL Screen_Ft <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Rados 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 />