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�-MONITORING WELL INSTALLATION REPOitSw <br /> Date: J CONSTRUCTION <br /> Total Depth <br /> Premise Address: <br /> Screen Length (from)_ _(to) <br /> Well No.: y Filter Pack (from) 7.5 (to) <br /> Bentonite (from) (to) <br /> �t Grout (from) (to) <br /> Inspector: p p� _a Drilling rig type / <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: c� ri casing <br /> Consultant <br /> Geologist ABOVF-GROUND <br /> COMPLETION CN <br /> COOMPLMPL ETIEOON <br /> SPECIAL PERMIT INFO. / ��Ground Surlaes + _ <br /> �.�r/ <br /> Distance to sewer line grout <br /> �� <br /> Domestic well on site - ( y'ln � <br /> ft. <br /> !f yes, location and distance - — ft. <br /> n. — .a <br /> — m <br /> — o <br /> = o <br /> c <br /> SAMPLING slatted <br /> srrc�an <br /> Holding Temperature = Brawl pad" <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Ile 9 <br /> Storage Location Casing type <br /> Blank Z fr. Screen /5 fr. <br /> Slot size ZO <br /> GROUTING Bags cement <br /> p Buckets bentonite <br /> Depth to water � ( Bags sand/gravel IZbO <br /> Mix Ratios Filter Pack type/size k 3 <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> /2- /7� a9 <br />