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-AONITORING WELL INSTALLATION REPT __i <br /> Date:2y/�// CONSTRUCTION <br /> Premise Address: �JJ/ut� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Drillerr-rel(r— casing <br /> �7,c height <br /> Consultant <br /> Geologist ._ <br /> ABOVE-GROUND <br /> COMPLETION CHRJSTY4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) n <br /> If yes, location and distance - <br /> . ft. <br /> ft. <br /> - O <br /> C <br /> SAMPLING = <br /> slotted — <br /> teC!cn — <br /> Holding Temperature <br /> Method — g"vW 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 /> r 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 /> Type of method <br /> EH 29 29 <br />