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. 1 <br /> MONITORING WELL INSTALLATION 11 SRT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: <br /> Screen Length (from)' (to) <br /> Filter Pack <br /> . (from) (to) <br /> Bentonite' (from) (to) <br /> Inspector: Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/chnstie box (circle one) <br /> Driller: <br /> casing <br /> height <br /> Consultant <br /> Geologist ._ <br /> ABOVE-GROUND <br /> COh�r'LETION C.}-W ZTY-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> C�tound Surface <br /> Distance to sewer line p� <br /> nn o <br /> If yes, location and distance - <br /> ft. ft. <br /> SAMPLING — <br /> c — -' - <br /> Holding Temperature - — <br /> Method vac pack <br /> Screening Method <br /> Tracking Sheet - (y/n) _ <br /> SPOILS <br /> Storage Method M_ ATERIALS/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 Type of method <br />