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,ONITORING WELL INSTALLATION REP( <br /> I <br /> Date:_ 6;t/d1;1e17 CONSTRUCTION <br /> Premise Address : Total Depth <br /> Screen Length (from) (to) <br /> Well No. : ^'V/ — /114/10 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: (S1 d+z ( Grout (from) (to) <br /> Drilling rig type_ <br /> Permit No. Auger O.D. I.D. <br /> / L Compledon - Stove pipe/cI r stie box (circle one) <br /> Drilling Company: OCi <br /> Drller: � F casing <br /> height <br /> Consultant / d <br /> 1 Geologist ^* A? (44t.D0 <br /> ABOVE-GACUND CtiA1SiY-BOX <br /> COMPLETION CCMPLE10N <br /> SPECIAL PERMIT INFO. ®®® Ground Su fact <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance <br /> ft. <br /> c <br /> SAMPLING — <br /> alaCod <br /> c <br /> todcn <br /> Holding Temperature <br /> Method gn" Pack <br /> Screening Method <br /> Tracking Sheet - Cy / n ) <br /> ft. — tto <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 /> Type of method_ <br /> EH 29 29 <br />