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• �" ff <br /> MONITORING WELL LNSTALIATION REP-e-T <br /> Date: " CONSTRUCTION <br /> Total Depth <br /> Premise Address: <br /> Screen Length (from) (to) <br /> Well No.: Sf���� 1 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 /> 1�I Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: IUIl� <br /> Dr cas izg <br /> rille <br /> Consultant <br /> Geologist A3CY:-GRCUND <br /> CrtrP►R'AN q-Ai5^!-30X <br /> CCMP��i CN <br /> SPECIAL PERMIT INFO. G=nd Siztacs j <br /> K <br /> �ra.T <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) -------,If yes, location and distance - h- <br /> —" 3 <br /> _ o <br /> s <br /> SAMPLING &oc.- <br /> socan <br /> Holding Temperature =( 72VVIpack <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage MethoMATF_.RIALS/DEVELOPNENT <br /> Contaminarion Noted - (y/C j) Casing type <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> 'V jO Bags sand/gravel <br /> Depth to water Filter Pack We/size <br /> Mix Ratios <br /> [nstallation Method L � � Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />