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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.: Filtet Pack (from) (to) <br /> Bentonite' (from) (to) <br /> Inspector: Grout (from) <br /> • (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion- Stove pipe/chnstie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant ' <br /> Geologist ._ <br /> �150VE-GROUND <br /> gh�r'LEfION C�-1A157Y-BOX • <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground 5urfxs <br /> Distance to sewer line orart <br /> If yes, location and distance- h. <br /> — m _ <br /> SAMPLING — F - - <br /> t to ttad — c <br /> soon — 2 <br /> Holding Temperature - _ <br /> Method ;r-ays►Pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <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 <br /> Installation Method Filter Pack type/size <br /> _ _.• 5urge_Block: - (_y_/n_) <br /> Quantity Installed ^ _ Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />