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MONITORING WELL INSTALLATION REt,.tT <br /> Date: CONSTRUCTION <br /> Premise Address: _ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: _ 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: - TT casing <br /> height <br /> Consultant + <br /> ti <br /> Geologist <br /> ---- ABO VE-G R CUN D <br /> COMPLETION C-H ISTY-BOX <br /> SPECIAL PERMIT INFO. ciraund Surface COMPLETION <br /> Distance to sewer line Aran <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance h <br /> (t. <br /> h. <br /> = a <br /> a <br /> C <br /> SAMPLING <br /> c to nad c: <br /> aeon <br /> Holding Temperature —_ <br /> Method <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <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 /> EH 29 29 Type of method <br />