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MONITORING WELL INSTALLATION REPO <br /> Date: CONSTRUCTION <br /> Total Depth <br /> Premise Address: S <br /> Screen Length (from) (to) <br /> Well No.: <br /> Y� y Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: c LL Grout (from) (to) <br /> Drilling rig type <br /> Permit No. D Auger O.D. LD. <br /> pa <br /> ( Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant 2& <br /> Geologist <br /> ABOVE-GROUND CHRLM-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuAacs <br /> Distance to sewer line L�D grout <br /> Domestic well on site - (y n ) <br /> If yes, location and distance - ''cc� Q ft. <br /> ' c <br /> o <br /> SAMPLING Monad � <br /> &scion <br /> = <br /> Holding Temperaturegnt= Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet (y n ) <br /> F—tt• — n <br /> SPOILS ,, <br /> Storage Method /62—CQ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location sdw Casing type <br /> Blank ft. Screen ld h. <br /> Slot size 000 <br /> GROUTING Bags cement 9 _ <br /> Buckets bentonite <br /> Depth to water = l� Bags sand/gravel <br /> Mix Ratios35 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 /> 605 /, - `� i®riw1l c1 <br />