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WONITORING WELL INSTALLATION REP <br /> J� <br /> Date: //// CONSTRUCTION 7 <br /> Premise Address: 7� l Total Depthy <br /> Well No.: I I Screen Length (from) (to) <br /> 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 /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant J� (,� i <br /> Geologist <br /> AROUND —QWT <br /> CONFL <br /> COMPLETION GIAISTY-BOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> � Surface <br /> Distance to sewer line1 o� <br /> Domestic well on site - (y/n ) �j p �— <br /> If yes, location and distance <br /> e <br /> SAMPLING <br /> an <br /> Q slatted c <br /> Holding Temperature = <br /> Method gravel Peds <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method ,C MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type //0�� . <br /> Blank fr. Screen h. <br /> GSlot size <br /> ROUTING <br /> Bags cement <br /> Depth to water / •�z Buckets bentonite <br /> Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ nEH 29 29 ) <br /> Type of method <br />