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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) <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 /> A-S O VE-GROUND <br /> c."JwLETct4 C}[AlST1-80X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> C�'ound 5urisce <br /> Distance to sewer line orout <br /> D„_ o�_tiO <br /> If yes, location and distance - ft. <br /> ft. fi. <br /> — - m <br /> SAMPLING <br /> t to tied _ — 20 <br /> Holding Temperature — <br /> Method 72vs{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 Filter Pack type/size <br /> Installation Method _____ 5urge_Block:_(_y_/n_) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br /> ' <br />