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OONITORING WELL INSTALLATION REP <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)-(to)- <br /> Bentonite <br /> from) (to)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: 111 casing <br /> T ca±ght <br /> Consultant <br /> Geologist ABCVE•GACUND <br /> CCMPLEi1CN COMPLEETICN <br /> CCMPLETICN <br /> SPECIAL PERMIT INFO. Ground S�'n <br /> prwt <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - (t. <br /> R. <br /> 0 <br /> SAMPLING �lonai <br /> sxion <br /> Holding Temperature = p+Y�F <br /> Method =_ <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) R. _ <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 />