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MONITORING WELL INSTALLATION REP,r-"-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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist .- <br /> ABOVE-GROUND <br /> COAFLEfION C7-IPLE <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface + <br /> Distance to sewer line of0`n <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> 4. <br /> M` c <br /> 0 <br /> SAMPLING slotted :.': - B <br /> aacton <^ '— <br /> Holding TemperaturevavW <br /> Method �' =_ P <br /> ack <br /> � — <br /> Screening Method — <br /> Tracking Sheet - ( y/ n ) <br /> ft. = IFtt. <br /> SPOILS <br /> Storage Method — MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <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 />