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MONITORING WELL INSTALLATION REI�uRT <br /> Date: ITI 0 CONSTRUCTION <br /> Premise Address: ��d� n►� 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 '4 <br /> Geologist •- <br /> ABCVE-GRMND <br /> COMPLETION CNAtSTY-BOX <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> �. ft. <br /> r <br /> C <br /> SAMPLING <br /> secicn '— <br /> Holding Temperature = 9"vIW F <br /> OCK <br /> Method = <br /> Screenin;Method <br /> Tracking Sheet - ( y/ n ) — <br /> ft. <br /> 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 /> 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 />