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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 /> Drill er: <br /> casing <br /> Consultant height <br /> * ' <br /> VIYA <br /> Geologist <br /> ABOVE-GROUND <br /> COwLET1oN CJiR1STY-BOX <br /> SPECIAL PERMT INFO, COMPLETION <br /> C�'bund 5urixa <br /> Distance to sewer line p� <br /> Da <br /> If yes, location and distance - ='� ft. <br /> --------- -- - <br /> SAMPLING -- o <br /> sbtted _- — c <br /> mon = 9 <br /> Holding Temperature <br /> Method ¢nvac Pack <br /> 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 <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 <br /> Type of method <br /> • <br />