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IONITORING WELL INSTALLATION REPL <br /> Dater/Yds 7 CONSTRUCTION <br /> Premise Address: / `° E �-�✓ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Q-F'� /f'1. Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. —61 ��'``�'` , Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: cas inq <br /> height <br /> Consultant ft <br /> Geologist <br /> ABOVE-GRCUND CttMM-BOX <br /> COI�LEf10N COMPIETICN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line_- (e� --1L Orli <br /> Domestic well on site - (y ft.) 7 <br /> If yes, location and distanceft. <br /> ft. <br /> Y - o <br /> SAMPLING M, <br /> o <br /> �soden — <br /> HoIding Temperature <br /> Method ' _ gmvw Pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> fL <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.2 Bags sand/gravel <br /> Mix Ratios V <br /> 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 />