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MONITORING WELL INSTALLATION 1, JRT <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/christie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant ' <br /> Geologist ._ <br /> ,ABOVE-GROUND <br /> COtiF LET1ON C4HRZ Y-80X <br /> SPECIAL PERMIT INFO. CchYPLETioN <br /> C-ra.md 5urfxa <br /> Distance to sewer line orout <br /> D st <br /> If yes, location and distance - -'� t. <br /> ft. ft. <br /> SAMPLING = o <br /> Holding Temperature -Method gra vel pack <br /> Screening Method _ <br /> Tracking Sheet - (y/n) <br /> ft• — tt. '. <br /> SPOILS <br /> Storage Method MATERLALS/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 /> EH 29 29 <br /> Type of method <br /> • <br />