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OONITORING WELL INSTALLATION REPO <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 <br /> from) (to)Inspector. Grout Mom)—(to)— <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> he<_ght <br /> Consultant T <br /> Geologist 1711r <br /> ABOVE-GROUND CFffi75TY BOX <br /> CCMPL ETION COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line <br /> Grout <br /> Domestic well on site - (y/n ) It <br /> If yes, location and distance - tt. <br /> tt. <br /> V' O <br /> O <br /> SAMPLING ` = o <br /> 810 J: <br /> aarion = <br /> Holding Temperature _ gr%VW F <br /> ack <br /> Method '* _ <br /> Screening Method M <br /> Tracking Sheet - ( y/ n ) <br /> tt. — M <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 />