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PONITORING WELL INSTALLATION REPC4 <br /> CONSTRUCTION <br /> Date: <br /> Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: 1�tl height <br /> Consultant <br /> Geologist ABOVE-GROUND CHRISTY-BOX <br /> OOMPI.ETION COMPLETION <br /> Ground Surface <br /> SPECIAL PERMiT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> if yes, location and distance - ft. <br /> tt. <br /> = a <br /> = c <br /> SAMPLING slotted = S <br /> eecion <br /> Holding Temperature 'ra1el P <br /> Method — <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blau ft. Screen h• <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 /> Surge Block: - (y/ n ) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />