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MONITORING WELL INSTALLATION REI T <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 /> Drilling Company: Completion - Stove pipe/clu-istie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant �► <br /> Geologist _ TI <br /> T► <br /> ABOVE-GRCUND <br /> CONFLETION CNAtsTY$OX <br /> SPECIAL PERMIT INFO. VWPLE7ICN <br /> Ground 5urfact <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft <br /> SAMPLING — o <br /> alot•.a.� ;:; c <br /> aac�cn <br /> Holding Temperature <br /> Method = — Gr+VS,pack <br /> xv <br /> Screening Method <br /> „., — <br /> Tracking Sheet - ( y/ n ) <br /> -- <br /> ft. ft. <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 /> GROUTTNG Bags cement <br /> Buckets bentonite <br /> Depth water — Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ ii ) <br /> Quantity Installed N Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of metliod <br />