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-'NITORING WELL INSTALLATION 1- .ORT <br /> • q <br /> CONSTRUCTION '. <br /> 4 <br /> Date: <br /> Total Depth (to) l <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/Christie box (circle cne) <br /> Drilling Company: <br /> C as ing <br /> Drille]7• height <br /> Consultant <br /> Geologist A, ;Vrz-GROUND cHR{S�480X <br /> cowpLETION COMPLETION <br /> Grcurd Surf=s <br /> SPECIAL PERMIT INFO. Grout <br /> Distance to sewer line h- <br /> en <br /> ft. i <br /> If yes, location and distance- ft. t <br /> 7 <br /> -� <br /> t to ttad _ <br /> SP2yqpI'ING .._ <br /> gr2y 4)ack <br /> Holding Temperature <br /> Method <br /> Screening Method - <br /> Sheet - (y/ n) _ <br /> Tracking <br /> • ft. R _. !' i1. <br /> SPOILS ., <br /> . •.��•T•ca r et c�E�LOPMENT <br /> Storage Method <br /> Contamination Noted- (y/n) Casing type <br /> Storage Location Blank Screen <br /> Slot size <br /> Bags cement <br /> GR_ OUITNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios <br /> Installation Method _ Discussed with geologist: - (y/ n) <br /> Quazitity Installed Type of method <br /> EH 29 29 " <br />