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gONITORING 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 /> 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/cluisde box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> T height <br /> Consultant b <br /> Geologist T <br /> ABOVE-GSCUND CtA*Iry-80X <br /> COMPLETION COMPL'TiON <br /> SPECIAL PERMIT INFO. 0��gray <br /> Distance to sewer line Ori <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> ft. <br /> r <br /> SAMPLING = <br /> 0 <br /> tloCod = <br /> soricn — <br /> Holding Temperature <br /> Method = ¢aVolyack <br /> Screening Method <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 type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />