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MONITORING WELL INSTALLATION RUORT <br /> Date: CONSTRUCTION <br /> Premise Address: 462 7 Total Depth <br /> Screen Length (from) (to) <br /> Well No.: / f— 7 Filter Pack (from) •'� ,(to) <br /> Bentonite (from) (to) <br /> Inspector: Grout fro <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pr e✓christie box '(circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-Gf OUND <br /> COMPLETION CHRLM-Sox <br /> �, - <br /> SPECIAL PERMIT INFO. COMPLETION <br /> G=ru Surface <br /> Distance to sewer line Grp' <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft. <br /> SAMPLING aio <br /> sec;on +k$ <br /> Holding Temperature_' <br /> Methodack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> ft. = ft. <br /> SPOILS t <br /> Storage Method MATERIALSEVELOP // <br /> NT <br /> Contamination Noted - (y/ n <br /> Storage Location 1 Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> i <br /> Buckets ben nite <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 /> Type of method <br /> EH 29 29 <br />